I had my 4th rotation in South Shore Primary care for Family Medicine in Far Rockaway. Here we worked with a very small team that included a secretary, a medical assistant/student, the PA and the other fellow PA students. We saw cases that ranged from annual well visits, to sinus congestions, to chest pain. As we were a primary care clinic, we did not have any walk in patients, however we did have telehealth visits. I really enjoyed this rotation because as students we were given a lot of responsibility since there was only one main provider here. This allowed us to feel more involved in patient care and feel like we were having more opportunities for hands on learning. A lot of out patients were also repeat and follow up patients which allowed us to see certain patients multiple times which allowed for continuity of patient care.
At the clinic we waited for the patients to check in and get called back by the medical assistant who would take the patient’s vitals. Some times when there were alot of patients we would assist in this as well. The medical assistant would then hand us the paper that had the patients name, vitals and chief complaint written. We would then go into the rooms first without the provider and get the patient history and information. We would then document this into ECW (which was a very new nad different EMR for me, so it was a little confusing in the beginning). After getting the patient visit started we would then present to the provider and go in with her and help with the physical exam. Alof of patients would come to the clinic needing blood work, which was out responsibility to do. This was the first rotation for me in which I was doing venipuncture so it was very helpful to learn proper technique and get enough practice to gain my confidence and skill set with this. Another procedure we learned to do was EKGs. This was also a first for me and was very helpful to learn how to properly place the leads and interpret the results with the PA. The PA would also discuss the patient’s lab work with us, and possible differentials for why certain levels were higher or lower then normal. Alot of our patients also came in with a history of Diabetes so we would be assessing their management and how certain medications are affecting their hA1C levels.
I remember one patient that we had came in for chest pain that was ongoing for a few hours, and did not think much of it. However after doing the EKG we noted that the patient was having an inferior wall STEMI. We immediately alerted the EMS, and ordered emergent labs. It was interesting to see how urgent patients get cared for from a primary care side. Another memorable patient I had was one who was coming in for post COVID cough that was lasting 2 months. This brought up a lot of interesting questions for me because a lot of patients will be coming into their PC for symptoms post COVID, as it is such a novel disease.
I noticed at the family care practice we were limited on how much we could do for the patients aside from refilling certain medications and starting a select few. However we would send out a lot of referrals for imaging and specialty care practices. Since the area this clinic is located is in the projects we had a lot of patients that were more on the aggressive side, so it was at times challenging to have patients understand why we couldn’t do certain things. A lot of patients were also very adamant on not wanting to be seen by a student or not wanting to have their blood work done by a student so it was a matter of respecting the patients wishes and stepping aside. A lot of patients also had a language barrier issue, as this clinic is older and does not have a translator service. However, we did had staff that spoke multiple languages which was helpful.
I think this rotation helped me grow more as a future individual provider as they gave us a lot of freedom and responsibility with the patients. We were trusted to do a lot of procedures and even put our input in for possible assessments and management. I am very proud of how I was able to pick up doing procedures such as venipuncture and EKG< as I have had no experience doing them. I also am happy with the patience I learned as a lot of the patients needed further explanation or wanted to just be left alone. I believe that I need to work on my skills of dealing with patients who are more aggressive and stubborn, as I tend to get more nervous and frustrated around them. I need to help how to be confident and have the patient understand that what we are doing is for their best interest.
Overall this was a great rotation! I really learned a lot and grew as a student. I was very concerned at first because the location of the clinic is not in a safe area, but the staff and fellow students helped me feel very comfortable and safe. This was also my first rotation working in a clinic rather then a hospital setting which was also a very different experience. I learned the importance of having good communication between the staff, as any issues can lead to poor patient care. It was very eye opening to see the different type of care that patients receive in a hospital vs clinic setting, as here we have the luxury of following the patients long term and spending more time care for them.
