My Family Medicine Rotation at SSS Family Medicine PC was excellent. This was one of my favorite rotations throughout my education. My preceptor was Dr. Streete-Smalls, and she was one of the best mentors I have had. This clinical experience was both informative from a clinical knowledge standpoint as well as a psychosocial standpoint. The community and patient population which I was working with is considered underserved, and often times our patients were not adequately “plugged in” with other care like dentistry, ophthalmology, etc. Moreover, many patients were not up-to-date on their health maintenance recommendations, such as colonoscopies, mammograms, PAP Smears, etc. This clinical experience was substantive in helping me to recognize that I would certainly consider a career as a Family Medicine PA. Furthermore, another realization that this rotation led me to is the fact that as a new graduate I would certainly like to practice in a setting where I am considered a “Generalist,” with my interests now centering around General Pediatrics, Emergency Medicine, or Family Medicine (or a combination of them with the inclusion of per diem work).

Memorable experiences from this rotation include caring for patients that had immigrated to the United States. A significant portion of the patient population whom I treated was from Jamaica, Guyana, Haiti, etc. Treating different populations involves cultural competence. For example, several of my patients believed in treatment with some of their own natural home remedies in addition to also “not believing” in taking vaccinations. During this rotation I was able to practice respecting the traditions of the patients whom I was treating in addition to performing education about other aspects of medical care like the reason why we have influenza vaccinations, etc. In some cases, patients were amenable to receiving the vaccination after the education, though there were others whom were not. Moreover, during this rotation I learned about how intricately psychosocial issues are tied into Family Medicine. Many patients were forthcoming about personal problems or mental health issues when directly questioned and screened during their annual physical. This served to remind me about how important it is to ask these important questions, as it is often the case that patients won’t reveal certain information unless directly asked.

An important part of the history during Family Medicine Annual Physicals is learning about other medical professionals involved in the care of the patient as well as when their last appointments were. During the visits, I would ask my patients about whether they receive regular dental care, if they have received women’s health services like mammogram or PAP smear, and whether, if indicated, they had received colonoscopy screening. Other questions/providers may be asked about as each patient’s needs are different. Other important parts of the history during visits include asking patients about their living situation and whether they feel safe at home, as well as directly asking about any intimate partner violence.

One thing I experienced in Family Medicine was patients that were non-compliant with the medications or recommendations of the team. During follow-up encounters where patients might describe that they didn’t take their medication or that they didn’t have the test ordered for them it was important for me to explore why that was the case in an effort to address the barriers. You learn of many barriers such as financial, personal values about medication, and others. Working in Family Medicine made me realize how important it is to build rapport with your patients in an effort to work together as a patient-clinician team to meet the teams established health goals.

During this rotation, I gained a lot of experience in the treatment of hypertension and diabetes mellitus type 2. Managing these chronic conditions often involves “tweaking” and optimizing the patients medications to get adequate control of the parameters in question. Under the guidance of Dr. Streete-Smalls, we discussed what changes were indicated under various clinical circumstances when patients were either uncontrolled hypertensives or uncontrolled diabetics. Her insight, in addition to some of the data that was presented to us by pharmaceutical representatives, was informative in learning, for example, that SGLT2 inhibitors reduce the risk of cardiovascular events. Moreover, I learned about using clinical tools like ASCVD guidelines to risk stratify patients that should receive statin therapy versus others that should not.

I had the opportunity to perform many technical procedures throughout this rotation including performing EKG, venipuncture, administering IM vaccinations, PAP Smear, etc.

One of my favorite components of this rotation was discussing clinical decision making with Dr. Streete-Smalls. After presenting my patients, I would describe my assessment and plan to my preceptor. We would often “bounce” our recommendations off of one another, and I certainly gained a lot of important information about treatment recommendations for various conditions.

One challenge that I had to overcome during my rotation was earning the trust of several of my patients. For example, after introducing myself as the PA-Student and asking whether I would be able to “get things started” for the patient by asking some questions and performing the physical exam, some patients would say “Ok,” though their body language suggested some initial lack of trust or rapport. Whenever I treat my patients I know that I need to build rapport with them and earn their trust, and it was a boost of confidence after completing the history and physical exam when, after wrapping up the visit with Dr. Streete-Smalls and the patient, the patient would compliment me, or my preceptor, about my professionalism and our visit.

This rotation was an excellent review of high-yield pathology like hypertension, congestive heart failure, diabetes mellitus type 2, COPD, and many others. I think it will certainly confer an advantage as I continue to prepare for my PANCE.

One thing I would want my preceptor and colleagues to notice about my work was the fact that I was vigilant about ensuring that my patients received the preventative care, referrals, and follow-up that they required.

I thoroughly enjoyed my experience at SSS Family Medicine PC with Dr. Streete-Smalls.

This is the conclusion of a 45-week journey – 9 rotations. Entering professional practice, I wish to continue in my endeavor to hone in as a compassionate clinician and diagnostician.