My fifth rotation was ambulatory medicine at StatCare Astoria, which is an urgent care center. This rotation I worked three twelve-hour shifts on different weekdays. While the providers occasionally changed, each day was similar. Throughout the day, whenever a patient would arrive for an urgent medical problem, I would see them independently. I would take a history from the patient and perform a physical and then present the patient to the provider. This allowed me to work on my presenting skills as well as discuss any important history components or physical exam findings that I should have included. The setup I had at urgent care also allowed me to think about differential diagnoses, make an assessment and think about what plan I would want to create for this patient prior to going back into the room with the clinician. I was grateful, similar to some of my other rotations, that I was solely working with PAs for all of my shifts. Especially at this urgent care, where there is only one clinician during the week, I was able to see the autonomy and confidence that comes with multiple years of PA experience. Urgent care is similar to emergency medicine, where it is important to know the pertinent negatives and positives you need to ask the patient and understand what is relevant in their history. 

This specific urgent care was unique to me, in that besides the ability to perform a urinalysis and some rapid tests such as Monospot, strep and COVID-19, there were not many labs we could do in the clinic such as a CBC. This made it even more important to understand whether the patient was in distress and needed immediate labs or imaging elsewhere or in the emergency department or whether they could be discharged home. Fortunately, a majority of the patients did not come to the urgent care for life-threatening problems. However, being able to risk stratify these patients and understand when they needed emergent care is a critical skill that I was able to work on while at this urgent care. In general, I feel that this rotation afforded me the opportunity to improve many of my procedural skills that I could not work on previously. During this rotation I was able to do multiple intramuscular and subcutaneous vaccines, PPD, venipuncture, establish IV access, rapid strep test, place simple interrupted sutures on a thumb laceration, pelvic exam with pap smear and irrigate ears due to cerumen impactions. Additionally, I assisted in wick placement for otitis externa, subungual hematoma evacuation, thumb spica splint, compression dressing for an ankle sprain and wound care. Looking back at the list stated above makes me appreciative of all of the procedures I was able to participate in and will help me grow my procedural skills as I continue my rotations and career. 

While I had multiple memorable experiences, one experience that I will remember was a female patient that was approximately 40 years of age with heavy vaginal bleeding. The patient reported her periods were usually irregular, heavy and long in duration, but reported this menses was longer than usual. The patient was presenting with multiple complaints that were pointing me in the direction of anemia. Unfortunately, the patient became upset when the clinician informed her that she should go to the emergency department for labs such as a CBC and possible blood transfusion if warranted. While I understood the frustration of the patient, this was a memorable experience in that it was one case where I understood why the patient should go to the emergency department from urgent care. The patient may have a low hemoglobin recently and may need a blood transfusion. If she was just discharged without being advised to go to the emergency department, she could syncopize and/or injure herself with a low hemoglobin (if this was the case). This case helped me recognize what condition or type of patient should be transferred to the emergency department for further medical care. 

I hope that the PAs I worked with saw that I was willing to learn, see patients on my own and discuss an appropriate plan for each case. I was always willing to see the patients independently and never hesitated, even when I was not confident in my assessment or plan of the patient. I plan to continue working on my physical exam skills, which I was able to improve while at urgent care, and start making my own definitive plans for the patient, as if I was the provider seeing them. This rotation allowed me to review a lot of topics and different aspects of medicine that I have not focused on in two months because of my previous two rotations (psychiatry and OBGYN). I intend to continue to use the history and physical exam skills, as well as the procedure skills, I gained on this rotation as I move forward in my clinical year.