How did it go? What have you learned? What can you improve? How do you plan to improve these new skills?

Family medicine was an informative, yet gentle start to my clinical year. My preceptor and the office staff were all kind and helpful. The hours were very manageable, usually 9am-5pm. One of the most important things I’ve learned through this experience is the impact that the provider-patient relationship has, especially in outpatient services like family medicine. When interviewing patients, they would often tell me countless times about how much they adored their primary provider there and how much they trusted her. I remember one patient in particular saying that she appreciates how the doctor does not treat her like a patient but like family. Another patient told me how the doctor once moved the office to a further location, but the patient continued to see this doctor because of how great she is, even though the commute was longer. Building these relationships is so important, especially in family medicine, where you may be the primary care provider for patients for many years. Family medicine taught me that not only is the medicine and treatment important but having that rapport with patients is crucial too, as you want to be someone the patients can trust in and come to in times of need. Things/skills that need to be improved on are discussed below.

How your perspective may have changed as a result of this rotation:

My perspective in the interview process, especially with elderly patients, is that not every single complaint has to be explored or dealt with at every visit. During the initial couple of weeks where I was gathering histories from patients, I found myself asking about every single ache and pain the patient was complaining of. While interviewing, I would say things like “So you’ve been struggling with ____, is there anything else you would like us to address today?” And some patients would continue to list other complaints that didn’t necessarily have to be explored at that visit. But in fear of missing something important, I would ask further about these complaints, going through OLDCARTS of each symptom. My preceptor at one point reminded me to focus on the most important/concerning complaint and to move on. This was especially the case for sick visits. For example, if a patient made an appointment to be evaluated for his sore throat, it was not the time to be asking for more information on his chronic osteoarthritic knee pain that is being followed by his orthopedist. As I’m writing this reflection, I’m reminded of some lessons taught to us during our Interviewing and Counseling class, where we were taught to focus on the most important issues and to keep moving in efforts to improve efficiency and be able to give time to other patients as well.

Types of patients you found challenging in this rotation and what you learned about dealing with them

Some patients I found challenging were those that were resistant to taking medications (for example being against taking a statin when hyperlipidemic) and those resistant to taking COVID vaccines. Especially regarding COVID vaccines, it was difficult to watch patients come to the office for medical advice but be opposed to recommendations for vaccines due to misinformation read online. It is hard not to feel frustrated for healthcare workers and researchers during this long pandemic when measures to decrease transmission are being refused. However, I learned that our role as healthcare providers is to simply give our professional recommendations, not have a debate, and to let our patients have autonomy with their bodies. My preceptor was an intelligent, empathic doctor, and I learned this valuable lesson through her grace and patience when dealing with these patients.

What did you learn about yourself during this 5-week rotation?

I learned that I should have been more confident in my skills before starting the rotation. Before clinical year, I was afraid I’d be awkward or uncomfortable with speaking to patients, because getting very personal/intimate information from complete strangers would seem like an intimidating task. However, I pleasantly surprised myself by being much more comfortable and relaxed than expected. Once I saw how open patients were with relaying their concerns to me, I became confident in my abilities and my role as a PA student there. Confidence is key!

Skills or situations that are difficult for you and how you can get better at them

One thing I can improve on is my assertiveness with asking for procedures. I may have been too timid with asking if I could perform certain skills like EKGs, venipunctures, pelvic/rectal exams, giving vaccines, etc. This was due to insecurities in my skills and mostly due to fear of being rejected by the preceptor or patient. I could have had more practice if I had just asked. I’ve learned that the worst thing that can happen with asking is that they will simply say no and that is okay! I plan to improve on this by getting out of my comfort zone and asking to do more. Moving forward I will be more confident in my abilities and my purpose of being there. With this mistake I’ve realized that this is my year to learn and improve on my skills!

How is this relevant to future rotations or your PA career?

I will carry all of these lessons to my future rotations and ultimately to my career as a PA. Especially as a PA, where I can potentially build relationships with patients, I plan to approach them in a professional, yet amicable manner. This family medicine rotation had encouraged my desire to learn more about my future patients’ lives outside of medicine; asking about their interests and goals in life. This will build rapport and give my patients a sense of trust in my recommendations. For challenging patients who refuse to take my medical advice that is based on research and meant for their benefit, I have learned not to take things personally and not to let their decisions impact my mood or behavior. While I will always care about the well-being of my patients, I will not let certain decisions affect me too significantly because this will ultimately build up negativity and burn me out. For my future rotations and PA career, I will focus on the patients’ most pressing issues, be more confident in my presence as a helpful role, and ask to do more procedures. Practice is the best way to improve on my skills, so I look forward to working on that this year.