When I first read the letters 'ER,' I thought for sure I was going to do an observation in the emergency room. My hope was quickly crushed when I learned ER stands for East Rockingham, which is a local clinic. Though my hope was slammed down, it was quickly raised as I found that one of my friends is a doctor there.
I showed up at 0800 or just a bit before. In fact, I arrived prior to my professor (who is a practicing PA at ER.), which is a good thing. My philosophy, I would rather wait for my proctor than have them waiting for me. So, after a quick tour of the place, (It's actually is a pretty neat lil' facility. Having your typical radiology, phlebotomy, general practice docs and the orthopedist stopping in twice a week.) we took a look at the schedule and realized our first patient had checked in. A 50ish yo/m (year old/male) complaining of possible Chigger bites. With all are patients that day, I had the opportunity of seeing them first.
After entering his room and introducing myself, I gathered a thorough history. With regards to dermatologic disorders, gathering a history is one of the major key points in diagnosis. He spoke of how the itching and bites had progressed from his feet and ankles superiorly. He exposed his orange spotted socks. Seriously, the orange pus filled vesicles had ruptured, spilling its slightly viscous contents onto his white socks.
Another point for dermatology, expose all the skin. Yep, you got it, this gentleman had bites and pruritus in his grown and perineal region.
Google always provides great imagery:
After presenting it to my proctor/professor we set him up with some tapered Prednisone and other over the counter (OTC) anti-itch stuff.
The next patients I saw was a 50ish yo grandma with her 4 yo granddaughter. G-ma not only came in for a follow up from her previous chest x-ray (CXR) and pneumonia (PNA), but she complained of post nasal drip and congestion. Diagnosed her with sinusitis and her granddaughter with an upper respiratory infection (URI).
Here is one thing in which I struggle with, the proctor wrote out a script (prescription) for the 4 yo and I felt that she didn't need anything. In fact, it was a typical cold that was traveling around. (The granddaughter had an occasional non-productive cough, no rhinitis and was running around the room. I know at night she would present with more symptoms, but...) My 3 yo had it not just a week prior. Anyways, I asked my professor about this and she stated that the prescription was just to please the patient. So, how often does a doctor write out a script just to appease their patients? I know it doesn't cost the individuals any until they purchase it from the pharmacy, but we as providers are just handing out drugs like their candy?! This principle of efficacy will forever remain in the medical field and with hopes that providers will use their best judgement and evidence based studies in making the morally correct decisions. (I know not every physician is just handing out meds.)
East Rockingham provided some great experiences. These 'hands-on' events provide the best learning environment for me.
I showed up at 0800 or just a bit before. In fact, I arrived prior to my professor (who is a practicing PA at ER.), which is a good thing. My philosophy, I would rather wait for my proctor than have them waiting for me. So, after a quick tour of the place, (It's actually is a pretty neat lil' facility. Having your typical radiology, phlebotomy, general practice docs and the orthopedist stopping in twice a week.) we took a look at the schedule and realized our first patient had checked in. A 50ish yo/m (year old/male) complaining of possible Chigger bites. With all are patients that day, I had the opportunity of seeing them first.
After entering his room and introducing myself, I gathered a thorough history. With regards to dermatologic disorders, gathering a history is one of the major key points in diagnosis. He spoke of how the itching and bites had progressed from his feet and ankles superiorly. He exposed his orange spotted socks. Seriously, the orange pus filled vesicles had ruptured, spilling its slightly viscous contents onto his white socks.
Another point for dermatology, expose all the skin. Yep, you got it, this gentleman had bites and pruritus in his grown and perineal region.
Google always provides great imagery:
After presenting it to my proctor/professor we set him up with some tapered Prednisone and other over the counter (OTC) anti-itch stuff.
The next patients I saw was a 50ish yo grandma with her 4 yo granddaughter. G-ma not only came in for a follow up from her previous chest x-ray (CXR) and pneumonia (PNA), but she complained of post nasal drip and congestion. Diagnosed her with sinusitis and her granddaughter with an upper respiratory infection (URI).
Here is one thing in which I struggle with, the proctor wrote out a script (prescription) for the 4 yo and I felt that she didn't need anything. In fact, it was a typical cold that was traveling around. (The granddaughter had an occasional non-productive cough, no rhinitis and was running around the room. I know at night she would present with more symptoms, but...) My 3 yo had it not just a week prior. Anyways, I asked my professor about this and she stated that the prescription was just to please the patient. So, how often does a doctor write out a script just to appease their patients? I know it doesn't cost the individuals any until they purchase it from the pharmacy, but we as providers are just handing out drugs like their candy?! This principle of efficacy will forever remain in the medical field and with hopes that providers will use their best judgement and evidence based studies in making the morally correct decisions. (I know not every physician is just handing out meds.)
East Rockingham provided some great experiences. These 'hands-on' events provide the best learning environment for me.
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