For my ambulatory care rotation, I worked with different providers during every shift. Each provider supplied me with different skills that I used to flesh out my history of present illness, develop a list of differential diagnosis, and create an appropriate assessment and plan. Across the board, all the providers I worked with emphasized the importance of documentation to rule out “the serious stuff . For example, one patient presented to the clinic with bilateral conjunctival injection and lacrimation. Upon further investigation, the patient stated he has a history of seasonal allergies and had been experiencing some rhinorrhea for a couple of day. On physical exam the patient had edematous, pale turbinates and his visual acuity was normal. This sounded like a classic case of allergic rhinitis but because he presented with  conjunctival injection, my preceptor informed me that we need to rule out ophthalmologic emergencies like orbital cellulitis. She taught me to refer to WikEM or Up To Date to help me figure out what questions I can ask. For this patient, we wanted to ask if he had any changes in vision or painful eye movements. We also examined the eye carefully to make sure there was no chemosis or proptosis. The last step was to document our findings. I enjoyed this way of working up the patient and found it to be helpful for developing my differential diagnosis so I think that I will continue evaluating my patients this way for my future rotations.

Prior to this rotation, I was not confident in providing patient education. Providing patient education is extremely important to me so this is something I worked on during every shift. The more I studied for the ambulatory care end of rotation exam, the more information I was able to relay to my patients. I supplemented my studying with slides and PANCE prep pearls instead of doing Rosh questions. By the time the 5 weeks were up, I felt like my patient education flowed like a conversation and I was able to speak to patients with confidence and answer their questions. My preceptors agreed with my counseling and were able to jump in at the end if they felt like I missed anything important. That being said, one thing I wish I had the opportunity to practice was IV placement. I was able to perform a decent number of procedures (venipuncture, urinalysis, cerumen removal, etc) but I did not get to place an IV in any patient. Typically, if the disposition is that the patient requires an IV, urgent care providers send them to the emergency room. I am hoping that I can develop this skill in other rotations like Emergency Medicine. Overall, I feel grateful that I was able to provide care in my community for 5 weeks and I learned that urgent care can play a role in mitigating health discrepancies in underserved neighborhoods.