My site evaluator for this rotation was Professor Sadat.

For my site evaluations, I submitted three H&Ps.

The first case was an annual physical for a 66yo Jamaican Female. Her PMH included HTN, HLD, DM2, and Primary Open-Angle Glaucoma. The patient was feeling and healthy and well on the day of her physical and was compliant with the treatment for her various conditions. Some of her health maintenance required updating, such as being overdue for some women’s health preventative services. A comprehensive physical examination was performed and there were no significant findings. Regarding health maintenance, an EKG was ordered for the patient in addition to routine labs like CBC (w/ Diff), CMP, Hemoglobin A1c, Lipid Panel, and others. Furthermore, the patient was given a script for a screening mammogram and for DXA. The patient did not wish to receive influenza, pneumococcal, or zoster vaccinations. A PAP smear was scheduled to be performed at the patient’s two-week follow-up. Her medications were refilled.

The second case was an annual physical for a 16yo African American Male. His PMH included myopia (with corrective lenses). He was feeling healthy and well, and a HEADSS assessment was performed. The patient is in the 11^th grade and reports performing well in school, earning B+ in almost all of his classes. He described what activities he enjoyed doing and reported feeling safe in his home environment. He denied any feelings of depression. Other questions related to substance use were asked, and the patient felt comfortable answering honestly. The patient was up-to-date on his immunizations and wanted to receive his flu vaccination at the visit. His physical examination was unremarkable. Routine labs were ordered for the patient. Influenza Vaccination and Men B vaccination were given to the patient. Counseling related to substance use was performed.

The third case was an annual physical for a 50yo Guyanese Male with 15 pack-year smoking history with no PMH. This patient’s vital signs revealed BP of 162/94. Given the fact that this was his first visit at the office, a diagnosis of hypertension could not be made. A complete physical examination was performed which was unremarkable. The patient was asked to return in two weeks for BP monitoring. Regarding health maintenance, this patient had an EKG performed, routine labs, referral for GI for screening colonoscopy, referral for Dentistry, and referral for ophthalmology to establish care and for glaucoma screening. Smoking cessation counseling was performed and the patient reported being amenable to attempting to “cut back” on his smoking with the goal of smoking only 5 cigarettes per day rather than 10 per day.

The journal article I selected was published in New England Journal of Medicine recently and was titled “Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans.” This article was important as the Family Medicine practice in which I was working saw primarily African Americans, many of whom were hypertensives. The article concluded that combination Amlodipine plus either HCTZ or ACEI was more effective than HCTZ + ACEI in reducing both ambulatory SBP and office BP.

The pharmacology cards included Meloxicam, Xofluza (Baloxavir Marboxil), Steglatro (Ertugliflozin), and several other medications utilized in the Primary Care setting that I was previously unfamiliar with.