Family Medicine Clinical Rotation

POP QUIZ: What's the most common cause of chest pain?

     For Family Medicine, our program has two four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I am at an Urgent Care clinic for my 1st rotation, and I'll be at a Family Practice Clinic for my 2nd rotation in the Spring semester.

     At the Urgent Care, you see a wide variety of age groups and complaints. From infants a month old to a 98-year-old woman (yes, you read that correctly) who's more active than I am!! It's much more fast-paced than traditional family medicine, and you don't get to focus much on the preventative side of medicine. A patient comes in with a complaint, you diagnose the complaint, and you treat the complaint. It's a "greet em, treat em & street em" way of  looking at medicine.

     Common complaints/diagnoses I saw while working:

• streptococcal pharyngitis (strep throat), influenza A&B, upper respiratory viruses, seasonal allergies, chronic bronchitis exacerbations, depression, cuts/scrapes, and orthopaedic injuries (my personal favorite!).

     I got to have a little fun at the office for college football opening day! Yes, I am based in Lexington at the University of Kentucky and do most of my rotations in Wildcat Country, but I will always be a Georgia Bulldawg at heart. I got some flak for wearing this to the clinic, but I was born in GA and went to undergrad there! I will always support the Kentucky Wildcats.....except when they play the Dawgs! #GoDawgs

     I did learn an interesting new technique for wound care, that I'd personally never seen before! It was actually for the 98-year-old mentioned earlier who injured herself while tending to her garden! When dealing with scrapes, try use as much of the patient's leftover skin to cover the wound. The BEST band-aid is your own skin, so we spent plenty of time trying to cover up the patient's wound with her own skin and then using steri-strips to hold it in place before dealing with the remaining open wound. This took plenty of patience as the scraped skin loves to roll up on itself! It's best with two sterile cotton swabs and some normal saline. Use one of the cotton swabs underneath the skin and twist the swab away from you to help unroll the skin before placing down to cover the wound. This ensures the most amount of skin possible is being used to cover the wound. It was definitely an interesting approach to wound care I'd never seen before, but it makes so much sense!! So if you have a big wound, try NOT picking off the skin before getting seen by a medical professional.

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the FM topic list is a beast):

• FM Topic List
• FM Exam Blueprint

     Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just FM):

• CURRENT Practice Guidelines in Primary Care
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Chest wall pain, AKA muscle soreness.

Characterized by at least 2 of the following: Localized muscle tension; Stinging pain; Pain is reproducible by palpation; Absence of cough.

The Optimist

CHALLENGE: When talking to friends/family, mention positive aspects about your day or life before mentioning what you do/did not like.

     For those who don't know me, I tend to complain about the countless little things that surround me. Basically, I speak before I think... A lifelong problem for me that my mom can attest to (I love you, Mom!). This may just be human nature, I know I can't be the only one! All these negative things that surround us seem to consume a larger portion of our minds/lives than the positive things. The unfortunate thing is that we are somewhat conditioned to allow these negative things to consume us. The media runs negative stories because we, as a society, tend to tune-in to negative stories more frequently than positive stories, so the networks get more views and more revenue. Negative posts on social media stir a reaction while positive posts seem quickly forgotten or simply scrolled past, but I always love me an adorable puppy post!

     I recently was overcome with stress from PA school. I looked at my life and realized I simply could not keep living this way, with so much weighing me down. With all the complaining, the negativity, the stress, I was near rock-bottom from a mental health standpoint. It was unhealthy, it was wearing me down, it was exhausting! So I challenged myself. I re-wired my mind to focus on things that would make me happy, more positive thoughts. Some advice I got from one of my professors was, "only focus on what you can control." While, I didn't make sense of my professor's advice initially, it later hit me following a mental breakdown after an extremely stressful week of tests, studying, and personal life struggles. How helpful those words of advice are now. We simply can't control everything around us, as much as I'd like to... So I changed my thought process, I switched to controlling what I could, and allowing the rest of the world to happen as it happens. 

     There was a video I was recommended regarding everything I discussed above, and it places a unique perspective on how we view the world and ways we can change our thought process...

     Following this, I have encouraged those around me to name off every positive aspect of their life before mentioning the negative. It's amazing how much their affect changes while talking about the positives of their day. So much so, that the negatives are either forgotten or don't seem quite so bad. Every time my girlfriend and I talk to each other on the phone, we are not allowed to say any negative things before something positive, and it is amazing to see how this little change can make our days seem so much better than we previously thought!

     Just from this minor change of communication, my stress has greatly reduced and I feel so much better than I did prior to this little "social experiment." I am happier, much less stressed, and I am better able to manage the countess responsibilities that pull me in every direction. Positive thoughts and only controlling what I can control!

New Health Challenge!

     So, this is somewhat an extension of my last post. Since PA school has begun at UK, I have been slacking off with diet and exercise. For those in the medical field or still in school, you know how much time and effort school, studying and clinic takes and the amount stress it causes! Due to that, I have put on about 7 lbs in 1.5 years, and lost considerable GAINZ... I have tried fad diets and had a couple health-related goals over this time-frame, but nothing really ever stuck or motivated me enough, until now....

     My friend Joe from undergrad at UGA and I have constructed a challenge. The goal is to lose a certain amount of body fat percentage over a few months. We will be utilizing a handheld bioelectric impedance device to track our results! The challenge started two weeks ago and will last until Dec 15th, when our Christmas breaks begin, as we would love to enjoy some good holiday meals with family!

• My Goal: to go from 19.2% body fat, down to 12% body fat
• Joe's Goal: to go from 17% body fat, down to 10% body fat

     If we both meet our goal, we will both "win." But, if one of us does not meet their goal, there will be punishment... What punishment you ask? The winner will get to post an embarrassing photo to the loser's Instagram. This can be an old photo, or it can be a new photo with a pose/outfit chosen by the winner. Yes, both of us can technically lose!

• To check the accuracy of handheld BIA devices: Handheld BIA vs. DEXA (PubMed)
• *These devices have an error range of +/- 3.5%, and ensure proper hydration and measuring results at the same time of day, under the same circumstances.*
• To purchase the handheld BIA device we are using: Handheld Body Fat Loss Monitor

I will not post many progress pics, but I will post the before pic (below; relaxed, flexed, side-relaxed) and and after pic once the challenge is complete! I will also post the Instagram photo if one of us does not meet our goal!!

To track my calorie intake, I use My Fitness Pal, (MyFitnessPal). This just helps hold me accountable for what I am eating, I would hate to have to log an unhealthy meal or snack and have that staring at me in the face! It's more motivating than you realize! And, the key to weight loss is caloric deficit (calories in - calories out = <0) I do not use the paid version of MyFitnessPal. I am also planning on exercising regularly and even adding cardio into my normal workout routine... I know, gross!

• If you would like me to post my normal workout routine/schedule, just let me know!

Macro Goals:

• Total Calories: 2,300 kcal
• Carbohydrates: 259 g
• Protein: 173 g
• Fat: 64 g