In the mid-rotation evaluation site visit, I present a patient with Schizophrenia disorder. This is the first patient I interviewed without attending doctor or PAs around, since she is a Chinese speaking patient. The patient is in her mid-30s, and she has hallucination, and she presented with suicidal thought that she reportedly wants to kill herself to join her friend, who died last year. She also had issues with her family, which may be a trigger to her suicidal ideation as well. This case allows me to explore all signs and presentations a patient with schizophrenia may have, like delusions, hallucination, disorganized thinking, negative symptoms include blunting of affect, anhedonia, reduced social drive, loss of motivation, lack of social interest, and inattention to social or cognitive input. Dr. Saint Martin agreed with my thought process, however, for differentials diagnosis, he points out that I should put schizophrenia as the top one, even the patient was diagnosed as schizoaffective disorder in the hospital. we discussed the differences between these two disorders and when patient has to sign release consent form.

For my final site evaluation, I presented on a pediatrics case of a 13-year-old boy who had history of oppositional defiant disorder. He also consumed cannabis regularly since they made him feel anxious. As such, he presented in an aggressive and agitation behavior, throwing skateboard at his mother that resulted in an altercation between the two and his mother called EMS and NYPD. While I was presenting my case, Dr. Saint Martin brought up some points that I did not focus on. For example, how much and how often the patient use drugs. In future differential diagnosis for my improvement, I will make sure to consider these factors and think a little outside the box to see if any other information is pertinent.