Types of patients you found challenging in this rotation and what you learned about dealing with them

The type of patients that I found challenging are the ones that present to the ED with psychiatric disorders. They are usually not a very good historian which makes it even more difficult for interviewing. They can be so anxious and angry to speak with you, or extremely agitated that we had to call the hospital police to prevent them hurting themselves or other people. In these situation, I would often have to carefully review their previous medical records and call their family members for most details about the history.  For the agitated patients, I learn that it is important to maintain a safe environment by getting security and additional staff involved.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

During my ER rotation, I have learned to focus on acute or life-threatening issues, and quickly figure out the correct management and critical care. I also learned how to build up a good list of differential diagnosis. And I had a lot of chance to practice basic procedural skills such as laceration repair, wound care, animal bite, splinting. The knowledge that I have gained here will be applicable in other rotations because it is always important to recognize life-threatening conditions. Since I was required to think fast on my feet and come up with differentials, assessments, and plans relatively quickly, I learned how to manage many acute patients at once since the ED requires prompt follow up when labs or imaging studies become available, which may change the treatment plan. In addition, it is important to gauge who to observe for longer, who to admit, and who to discharge since there is always a constant flow of patients that need to be seen.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

My perspective has changed for IV drug user as a result of this rotation. After this rotation, I become more aware of the IV drug abuser population. IV drug administration can lead to serious health problems. Most drug addictions begin through less direct methods such as ingesting the substances or smoking. But as dependence increases, they begin abusing drugs though IV injection. I was able to evaluate and manage some HIV patients that are part of the underserved community, many of which do not have insurance or are homeless. In addition, I also learn how to deal with some angry patient who were waiting for the provider for a long time. I find that many of the patients are unhappy after waiting hours in the ED (which is to be expected). The initial approach when talking to the patient is very important since you can de-escalate patients before they become agitated or problematic. I also helped those type of patients with getting food or water, going to the bathroom, or with their other needs if I saw that anyone needed help to provide the best quality of care that I could.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

For the following rotation, I would like to improve on coming up with management and treatment plan. Throughout the previous rotations, I often have to rely on my preceptors or the other providers that I am working with. For the following rotations, I would like to start getting used to think like a provider. After interviewing every patient, I would try to have my own management and treatment plan and I would ask how my plan could have changed or be different in order to provide better health care to the patients. Also I would like to learn more psych medications for my psych rotation.