My Ambulatory Medicine rotation at Statcare was high volume and educational. This clinical experience has shown me that I could potentially see myself working in an Urgent Care setting on a Part Time or Per Diem basis. Several aspects of the experience that made me feel this way include the fact that you always need to be alert for potentially high acuity patients (which is exciting to me!) while at the same time you sometimes need to function as a primary clinician for the patient. I like the spectrum of care provided in the Urgent Care setting.

Memorable experiences, and patients, I’ve had included particularly challenging situations. Many of the patients that go to Urgent Care are Self-Pay. As such, it is often very challenging to practice medicine the way that the clinician would like to. Shared decision making between the patient and the clinician regarding what tests to order, whether to begin antibiotics, etc. are often limited due to the financial burden. One patient I can recall was a woman in her mid-30s that came in with severe abdominal pain and was febrile. The team had to ask her what portions of care she wanted (IV Fluids, Blood Cultures, Dose of Antibiotic in the Urgent Care). This was one aspect of care that particularly upset me.

Another memorable patient population I got to experience in the Urgent Care setting were patients that come in with requests – and sometimes demands – for antibiotics or other treatment that clinically is not indicated at the time. It was impressive to see the ways in which clinicians could explain to the patient that at the given time, antibiotics were not indicated and would sometimes offer the option for delayed antibiotics. One aspect of Urgent Care that needs to be considered is the “Patient Satisfaction” portion, which is often less-so considered in hospital settings.

During this rotation, I was exposed to several new procedures related to Ambulatory Medicine. I had the opportunity to perform several Ear Flushes. Additionally, this rotation gave me my first, and subsequent experiences, in performed I&Ds. I also had the opportunity to practice skills like suturing, IV insertion, and a lot of venipuncture.

The clinicians with whom I worked shared valuable clinical pearls in addition to some useful physical examination tips. One clinician with whom I worked, Dr. Suk, taught me to help differentiate whether patient’s had chest congestion or upper airway congestion by asking the patient to cough while auscultating their lungs. This was useful in helping to differentiate Acute Bronchitis from other diagnoses.

Some challenges that I had to overcome were adjusting to the pace in Urgent Care. Given the high volume of the practices, sometimes it means asking more direct questions and getting directly to the root of the problem and physical exam. It involves being more effective in question asking as well as in your physical exam and being able to gently redirect your patients when they begin straying from the reason for their visit. It definitely took me several weeks to begin shortening my visit times while performing thorough exams and delivering quality care to my patients. Another challenge I had was committing to a particular diagnosis when patients came in with various combinations of symptoms. This took practice, and approximately 1.5wks into the rotation I was able to more confidently diagnose my patients rather than just telling the precepting clinician what the patient was complaining of, their physical exam findings, etc.

Oddly enough, during this rotation I saw several patients with Pterygium. It was interesting to see and I shared the physical exam finding with my preceptors as well as with the other staff (many of whom are pre-PA, pre-MD, etc.).

This rotation was an excellent review of mainly respiratory complaints but also a nice variety of lacerations, abdominal pain, and other complaints. One thing I could see in my experience in Urgent Care is that many patients utilize these facilities for Primary Care. The clinicians with whom I worked often had excellent rapport and follow up with their patients.

One thing I would want my preceptor and colleagues to notice about my work was the fact that I was always ready and willing to get started on the next patient. My mindset was such that I wished to maximize the number of patients I saw/started on/presented to the supervising clinician so I could hone in on my interviewing skills, physical exam, diagnosis, and presentation.

For the following rotations, I wish to improve on coming to diagnoses and my plans. Particularly, I need to work harder on the supportive care measures and other measures that patients may utilize, other than just antibiotics or the treatment indicated for their conditions. Counseling is important and can both improve the patient’s illness as well as make them feel that they are being heard and contribute to a better patient experience.

Overall, my experience at Statcare for Ambulatory Medicine was challenging and fun. I’m thankful for the entire team, especially the clinicians with whom I worked, for making this experience educational and giving me a lot of autonomy.