For my first site evaluation, I presented an H&P detailing a patient that I saw in the ER prior to his admission to the medicine floor. The patient was an 80 year old man who presented to the ER with rectal bleeding for 2 days. The patient had a history of prostate cancer s/p prostatetectomy and recurrent rectal prolapse with recent proctectomy. I presented a few differential diagnoses that I considered may have been the cause of his bleeding. This included anal fissure, anal polyps and internal hemorrhoids. We discussed the initial workup for each of these possible causes of bleeding would be a colonoscopy. As such, GI was consulted to workup the patient for lower GI bleed and complete the colonoscopy. During the site evaluation, I learned the importance of including all lab values and conducting a proper physical exam. I also learned how to improve my H&P and which information is most important to include in the “Assessment” section. While I had previously believed that it was important to include a significant portion of information that was reported in the HPI, I was taught that this is not necessary and only a brief summary of the patient and the present problem should be included. I also prepared 5 drug cards for the site evaluation.
During the second evaluation I prepared a second set of 5 drug cards and we reviewed them together. I chose to include drugs such as Tenecteplase, Lisinopril and Omeprazole because these were drugs that I saw prescribed many times throughout my Internal Medicine rotation. We focused on the side effects of medications particularly in regards to whether the medications may have possible nephrotoxic or hepatotoxic effects. It is critical to ensure that the medications prescribed for patients will benefit the patient and won’t adversely affect them. I also presented a second H&P during this visit. One of the cases I prepared presented a patient with an acute CHF exacerbation. This provided me with an opportunity to review the guidelines for managing acute CHF exacerbations. I also made sure to incorporate the adjustments the site evaluator suggested during my first site evaluation into my second and third H&Ps which I completed for this rotation. I was glad to see that writing H&Ps was becoming more natural to me and I felt that I was learning how to differentiate which information and questions were most critical to include.