For my first site visit I presented 2 H&Ps. My first H&P was about a female with lower abdominal pain for about of week. During her workup, we found hematuria on the UA and combined with history came to the diagnosis of nephrolithiasis. Since the patient’s symptoms were improving, we recommended time off of work and supportive care, including hydration and pain medications as needed. My second H&P was a teenage boy who had punched a wall and was having hand pain. Given that this was the typical “textbook” description of a boxers fracture, along with where his pain was located on the 5th metacarpal, the diagnosis was pretty straightforward.

For my final site evaluation I presented on a female with sinus congestion and other cold like symptoms. With evaluation of the severity and duration of her symptoms, my preceptor and I discussed which patients would receive antibiotics in a suspected sinus infection. Since our patient was experiencing double sickening (her symptoms had improved and then worsened again), we opted to prescribe antibiotics in her management. The journal article I presented on during this final site visit discussed the effectiveness of antibiotics in acute bacterial sinusitis. My site evaluator and I discussed the efficacy of antibiotics in treating acute sinusitis and when antibiotics should/should not be prescribed.

I received a lot of helpful feedback, especially during my mid-site evaluation that I later applied to my final site evaluation. We discussed how to write an assessment that is concise and what should/should not be included. I think I effectively used this feedback to write an assessment on my last HPI that encompassed all relevant information. Also we discussed forming differentials and at what point during the interview they should be formed. We also discussed which parts of an exam should be emphasized in specific chief complaints, such as being sure to document all lymphadenopathy in a sinusitis case.

I will continue to use the information I learned about forming an assessment and a plan that includes important patient education for my future site visits. I feel a lot more confident about writing my assessments and am more understanding of what is relevant to be included and what can be excluded to make it more straightforward and to the point. The site evaluations were very helpful also at helping me to re-order my HPI to make it flow better.