Dr. Davidson was my site evaluator for my long-term care rotation. For this rotation, I presented Three H&Ps, two drug cards, and an article. Dr. Davidson also gave me two assignments. The first assignment was to research, and understand MMSE, and Mini-COG exam, how it is used, and what it teaches us about the patient’s cognitive function.  The second assignment was to research ALS pathophysiology, and how to diagnose it. Both assignments helped me understand my patients better, and how to better perform physical exams.

For my first site evaluation, I presented a patient complaining of hematuria. The patient had Foley catheter in place due to pyuria and needed help with all ADL. The patient had multiple comorbidities, HTN, CKD, prostate cancer, and ALS. The patient wasn’t aware of hematuria because of his Foley catheter. During a regular follow-up, his foley bag was bright red and cloudy. A urine analysis and urine culture were ordered and the patient was found to have a UTI caused by pseudomonas aeruginosa, and was treated with Cipro. The feedback I got from Professor Davidson was that I needed to do a full MMSE because the patient’s reliability was questionable and we need to know if the patient is cognitively intact and if the history he is providing is reliable. The other feedback I got was to note whether his HTN, and CKD are stable or not in my plan section.

For my second site visit, I presented a patient who was admitted to St. Albans for rehabilitation status post a right femoral artery aneurysm. Dr. Davidson noted I did improve from my first H&P as I had done a better job at performing a neurological exam, and musculoskeletal exam, but needed to go into more detail. Even though I performed a musculoskeletal exam, and neurological exam on the patient, Dr. Davidson noted I should check every joint for pain, movement, and sensory since the patient is status post major surgery and in for rehabilitation. Dr. Davidson also gave feedback on how to describe a patient’s surgical wound, which was very beneficial as surgery is my next rotation.

My site evaluation helped me better organize my thoughts and prepared me to present complicated cases to my preceptors in the future. Because of this rotation, and the constructive feedback I received, I’ve become better at writing more detailed H&P.