For my site evaluation during my first meeting, I presented one H&P, and for my second meeting I presented two H&P.  For my first site evaluation I presented a case of a patient with diarrhea for 1.5 months. The patient had originally gone to Mexico got sick and got better shortly after, then went on another vacation and got sick again. For this patient, we ordered a stool culture and recommended drinking fluids to replenish electrolytes from diarrhea. The patient also lacked a primary care physician and had severe anxiety that could have made his symptoms worse, and the recommendation was to also see a mental health professional. The provider and I set up the patient with a referral for his anxiety.

For my final site evaluation, I presented two cases, and a journal article about Bempedoic Acid as an alternative to patients who are intolerant to statin. The second case I presented was a patient with possible shingles given the onset of his symptoms which were tingling, and burning before a rash appeared, and affected one side. My final case was a teenager presenting with a status post-basketball injury, and diagnosed with a Salter 2 Harris fracture, and it was with this patient that I was able to apply my first ulnar gutter outside of the clinical skills class.

Professor Rachwalski gave a lot of feedback, and the feedback was about my physical diagnosis exam. My physical exam wasn’t as detailed as it should be. For example, for the patient with shingles I didn’t go into detail in describing the rash as “macular”, “raised”, “liner”, and size. For my third case, I noted on my physical exam the patient was tender to palpation to the 5th right digit, but didn’t specify if it was DIP, PIP, or MCP joint. Additionally for my first case, the patient with diarrhea I didn’t quantify the diarrhea episodes or consistency of the diarrhea. My biggest takeaway from the feedback I received was that I need to be more descriptive in my physical exam findings. Also, I need to quantify my HPI as well, I need to get more details such as how the pain felt, whether is it “throbbing”, “stab-like”, and the pain-scale this will help pain a better picture for anyone reading my HPIs.