Family Medicine Rotation Review

I completed my six weeks Family Medicine core rotation at JPH and also on offsite locations.  The rotation is basically concentrated in clinical setting and also in geriatrics. I honestly did not enjoy it because I did not like working in the nursing home. I did clinic hours in the hospital but then I had to drive to over 15 nursing homes and take care of patients there. 
The rotation basically dealt with typing up history and physical notes on Practice Fusion software. I had to type it up and then the doctor would do his checkup and retype his own notes. I didn’t see the reason I had to type it unless it was for my learning experience because the student’s notes are never accepted.
I hated working in the nursing homes in Chicago because I felt bad for the patients there. Majority of the nursing home patients look depressed because their families dump them there and rarely visit them. Only a few of the residents are jolly because their families come often and take them on outings. One of the nursing homes was right across the street of a graveyard; that is so cruel, it’s like telling the nursing home residents where they will go next. Also, in some of the nursing homes the nurses have a serious attitude issue with the students so, be aware of that and be extra polite to them.
I got an A grade out of it because it was easy in my opinion but I did not enjoy it because of seeing the condition of the senior patients was disappointing.

What’s Going on with Clinical Rotations

Hello hello, it’s been a while since any posts have been made and trust me I’ve been very busy with rotations and so that’s why things are hectic. I am in rotations currently and I love it. I never thought, as a medical student, we could be as invasive as possible during rotations, but we are.
Last year when I was studying for USMLE Step 1, I always talked about what it would be like to be in the position I am right now and now here I am, thank the Almighty. It’s a great feeling that you are now considered a doctor, even though you don’t have the title, you are a doctor after passing USMLE Step 1.
When I was working at the nursing homes for my Family Practice rotations, a nurse comes up and starts off calling me a doctor. I stopped her before she can say any further and told her that I am only a medical student. She continues and tells me that it’s the same thing since we do what the doctor is supposed to do. Apparently, we spend more time with the patients than their real doctors. We medical students listen to the patients, conduct the physical examinations, and report what we find and the labs we get to our attending doctors. The doctors will then see what our finds are and spend couples of minutes with the patients and then he will make the assessments and plan for treatment.
Unfortunately, it’s heartbreaking to see the pain and suffering of the elderly at the nursing homes. The elderly are there because their own families cannot take care of them because the elderly requires oxygen and constant monitoring that they need to be there. Sometimes I think what happen to the old days of taking care of one’s parents in one’s own home. Our parents raised us from childhood and took care of us when we were young so it’s our obligation to take care of them while they are old. The ground reality is, the children of the elderly residents of the nursing homes are not from good socioeconomic places so they have to work and cannot attend to their parents.
I’m learning a lot about people and how to take care of them while being in rotations. However, it’s not helping me as much for the USMLE Step 2 CK. It’s only helping me for the USMLE Step 2 CS because we have to do H&Ps and progress notes and make diagnosis from what we find.

Getting Used to SOAP Notes

Currently I’m in Family Medicine clinical clerkship rotation and it’s kind of hectic when you have over 60 patients to see and you have write soap notes for all of them. During rounds, the attending doctor asks us what did we find that was abnormal since the last progress note and we report what we find. If there is no abnormality then we just report that and also we report if there is a change in medication.

Honestly, it is a burden to go through those patients’ charts and update the progress report that I do. It takes time to go through those charts and trying to read the notes written by people who needs to go back to grade school for writing lessons. Medical students who were assigned those patients before us wrote the previous progress notes in the charts so each progress note is written by a different individual. However, few progress notes are written by attending doctors and it looks like as if they are writing another language.

When writing a soap note we write something like the following:

56 y/o AAF with PMH of HTN, DM, hyperlipidemia, and depression. On questioning she has no complaints.

The following is in short hand for 56-year-old African America female with past medical history of hypertension, diabetes mellitus, hyperlipidemia, and depression. It took me a while get the small short hands memorized but eventually I got through so when I see it I get it. Also there is a pattern of what drugs are ordered for the patient. For example for Extra Pyramidal Symptoms (EPS) the doctors always prescribe benztropine for Parkinson’s like symptoms which can be caused by the side effects of an antipsychotic drug such as haloperidol.

Through practice and monitoring the patients you speed up and it helps so much in your clinical skills in soap notes writing.