My eighth rotation was internal medicine at New York Presbyterian Queens. I worked three twelve-hour shifts on different weekdays and did one week of night shifts and one week on the stroke team. Every few days I would work with a different PA, allowing me ample opportunity to understand how each PA handles their workload and their patients. Each morning I would get a list of the PA’s patients, which typically ranged from ten to twenty. If there was a computer available, I would use my epic access to read about each patient and what consults/labs/imaging etc. had to be completed during the shift. If I did not have access to a computer, I would simply do this with the PA I was assigned. After detailed chart reviews, we would round on each patient. Rounding on patients could occur on patients in the emergency department, early treatment of admitted patients (ETAP) or on various floors. It is easy for labs or consults to be hidden within all the written notes on epic, so I learned the importance of thoroughly reviewing the charts and updating the handoff section after each change. Additionally, I learned the importance of medication reconciliation when the patient is first admitted. I was able to participate in this by calling pharmacies and obtaining/verifying the medications that a patient is currently taking.

When I was on this rotation in this department for my long-term care rotation, there were not many procedures for me to participate in. This may have been due to the number of students on the rotation at that time or being assigned to PA’s that did not have any possible procedures. However, this rotation I was fortunate enough to be able to participate in several procedures. I was able to draw blood, place IVs, do and assist in NG tube placement, perform ABGs and even remove a central line. I also learned/reiterated other important skills such as connecting fluids to the patient’s IV and drawing urine from a Foley catheter for urine analysis and culture. All these procedures were very important for the development of my skills, especially because I hope to work in the emergency department after graduating and passing my boards. Similar to my previous experience in internal medicine, I enjoyed being able to participate on the stroke team. This time I was able to round on the stroke patients on the floors, allowing me to work alongside the neurologist and neurology PA. It was intriguing to see the day-to-day changes in these patients and see their deficits such as profound weakness, aphasia, or dysarthria.

There were several memorable experiences on this rotation. One experience I will remember is a 34-year-old male with a brainstem stroke. I did not see the patient during their initial presentation with the stroke team but saw him the following week while on the floor with the neurology team. The patient received tPA despite being outside the time window because the benefits outweighed the risks. It was remarkable to see, according to the PAs who saw the patient initially, the improvement in his right sided weakness and dysarthria. Another experience was with the son of a 95-year-old patient. The son was very unhappy with the patient’s care. Unfortunately, the patient was in ETAP for a few days because of lack of beds on the floors. The son was also not happy with the communication during his mother’s stay. The PA I was with went through the entire list of the patient’s concerns and gave him the time to express those concerns. This further reiterated the importance of communication not only with a patient but with their family. Even though you as the clinician may be busy, each patient is a person and needs to be treated as such. A family deserves to be updated accordingly and be given the opportunity to speak to hospital staff.

As I mentioned previously when on this rotation in the summer, the rotation helped me further understand complex patients and the multiple teams you need consulted in order to provide the best treatment and care possible. Additionally, I will use my knowledge from being on the medicine side to understand when a patient should be admitted to the hospital. As I finish my last rotation in family medicine next month, I will remember to evaluate the patient as a whole and allow for the patient to express themselves to address all concerns and provide wholesome care.