Going into my first rotation, I felt extremely nervous; despite all the hours of classroom time and studying, I worried that I would go in there and find that I did not know anything. Of course, I was extremely relieved to find that this was not the case, but I was still nervous through the first couple of days.

One of the first things I realized in my Family Medicine rotation was that the treatment guidelines we are taught in class are not necessarily carried over to practice. I noticed this most in the treatment of acute bronchitis and acute sinusitis. While we are taught that antibiotics are not indicated in the treatment of these conditions unless the patient’s symptoms persist without improvement after a specific amount of time or they present with certain other symptoms. I think this is where defensive medicine comes into play; as clinicians, we do not want to miss a diagnosis and produce a poor patient outcome. Of course, the patient’s expectation plays a huge role in this, too. When patients feel sick, they expect to go to the doctor and receive a treatment that will make them feel better. If they do not, they leave dissatisfied and may choose not to return to the office. As providers, I think it is important to educate the patients on this matter by introducing the risks of unnecessary antibiotics.

My biggest challenge in seeing patients and producing an assessment and plan for them is the list of differential diagnoses. In an outpatient setting like this, I found it very easy to fall back into the same three differentials because I was carrying forward my experiences with patients I had seen before into the new ones I was seeing. Going forward, I have to keep reminding myself that, while I cannot and should not erase my prior experiences, each patient is a new one and must be treated as such. For that, I must keep an open mind and develop a broad set of differentials. I think this will come with more experience and exposure to different areas of medicine.

I am very glad to have had Family Medicine as my first rotation. This rotation was very broad in that, while most of the patients I was seeing were probably hypertension or diabetes 3-4 month follow-up visits, I was also able to see a lot of sick visits, musculoskeletal complaints, annual visits, pediatrics, any gyn visits. The breadth of this experience will surely help me in the rest of my rotations because I have gotten some exposure in all of those other areas, save surgery. Going forward, I hope to be able to apply what I have learned in other areas of medicine and continue building my knowledge base and experiences.

One thing I learned about myself through this first rotation is that, while I consider myself to be a very outgoing and extroverted person, I can be pretty shy when it comes to seeing patients or asking to perform procedures. In the first couple of days of the rotation, I patiently waited and asked to see a new patient. I think a lot of that came from my worries that I would be inconveniencing the patients my asking them all the history questions or examining them. After speaking to a friend, I realized that this rotation would only give me as much as I chose to get out of it, so I started jumping up to see the next patient and asking, “Can I do that?” I hope to take this sense of confidence with me in the next eight rotations because I want to be able to make the most out of each of these experiences. I think that will also help me stand out among my preceptors and foster a sense of trust, provided I do it well.

Most of the patients I saw were 50 years old and older. At 23, I felt that I had a hard time with the patient education aspect of the experience because I did not want to overstep and have these patients feel like I, someone who was sometimes less than half their age, was reprimanding them on their diet and exercise habits, smoking or drinking, or the repercussions of uncontrolled hypertension or diabetes. Later on in the rotation I just started going for it because my age or the patient’s age should not exclude the patient from having the best possible outcome. I think having this experience and realization will be valuable as I go forward because I will be able to better handle all patient populations. I think I did a really good job in building relationships with the patients and making them feel comfortable. I hope to continue this and get even better at it.