This was my first rotation, and my first experience in an urgent care setting. I was exposed to an environment where the staff all knew each other (at least somewhat, since most people did not work every day), but the patients were usually new. I was initially concerned about getting used to the daily routine and understanding my role as a PA student, but after a few days, I got more comfortable and was able to assist and eventually perform hands on procedures on my own, as well as take proper history and physicals from patients. I also learned how to work the computer and the EMR system- eclinical works, so that I could put patient information directly into the system rather than just writing it in my own personal notes. 

A skill that I found challenging was coming up with accurate differentials for vague complaints, especially orthopedic complaints. Many people came in to the urgent care over the past few weeks for orthopedic complaints, and while some were more obvious (like frozen shoulder), some complaints were not as clearcut. I noticed that depending on a patient’s level of pain tolerance, fractures could present very similarly to a simple bruise or sprain. I also had difficulty deciding what type of physical exam to do for orthopedic complaints, as well as how to interpret certain findings, since decreased range of motion and tenderness on palpation could lead to various differentials. I can improve on this by reviewing various orthopedic issues and distinguishing factors for specific issues. 

Some types of patients I found challenging were people who spoke different languages, which resulted in communication barriers. It was often difficult to gain a proper history and even sometimes to perform a proper physical exam when the patient and I did not understand each other. I also just felt so bad that we were both struggling and I was not able to effectively communicate. I am getting better at asking questions and explaining things in different ways to get past the language barriers and communicate as best as possible to provide the most effective and quality care, since language barriers are something I know I will face a lot in whatever field and whatever area I find myself working in. My preceptor also told me about a “google translate” app that can help translate information that a patient is saying in order to help communicate more effectively. I did not need to use it for this rotation since most of the time we were able to find some way to communicate, but I downloaded the app and am excited to use it if ever necessary. 

Something I really got to experience during this rotation, which I’m sure I will see more of as I continue in future rotations, is the importance of the PA’s role not only in diagnosing and treating specific diseases, but much more broadly in being there for patients emotionally, as a listener as well as reassurance and calming anxiety, as well as a teacher and educator for general health practices. I had various opportunities to be this figure for patients during my rotations, 2 of which really stuck with me. There was one woman who came in for simple blood work, but as I was taking her history she began asking me questions about COVID, and further confiding in me about all her fears and anxieties. I spent a good amount of time speaking with her and was able to be a listening ear as well as a calming and reassuring figure for her, and through the conversation, I was able to recognize a need for further neuropsychiatric treatment and arrange for proper referral for her. A different time, as I was performing vitals on a man who had come in for lingering back pain following COVID, I noticed that his blood pressure was extremely high, which was very concerning to me. I asked him if he had a PCP, which he denied (unfortunately very common, especially in the urgent care population). I explained to him that his blood pressure was very high and educated him on the dangers associated with high BP and the importance of getting it under control. He then proceeded to relate to me the personal struggles he had been going through over the past few years and the increased stresses he believed were leading to his high blood pressure. Once again, I was able to provide a listening ear and an empathetic shoulder to a man who clearly needed it, and afterwards, I was also able to explain to him the importance of obtaining a PCP and getting his blood pressure under control, information he was much more willing to listen to and take to heart after I had given him the time and care to hear him out. In our PA training, we are always taught about the importance of giving patients full time and care, but often as a PA we just do not have the time. I think we have a unique opportunity sometimes as students to give extra time, care, and education to patients who could really benefit from it (namely, since we do not need to spend as much time taking notes and taking care of other responsibilities) and I am so thankful that I was able to utilize this opportunity throughout my first rotation. 

Something that I learned about myself during this rotation was that I love to learn and try new things. Especially due to COVID, we did not really have the opportunity to practice clinical skills, and I was very nervous to get thrown into it. But from the first day, I asked to assist in venipuncture and EKG’s, and from then on, I went on to take on any hands on skill that was available, which really helped me learn. I also realized that many patients are supportive of students and want us to learn! When I told patients I was a student and I was new at performing the procedures, they were so supportive and eager to discuss my journey with me and provide encouragement and support! I know this is not always true, but I really appreciated seeing that. 

Another thing I noticed was the importance of the group environment and inter professional collaboration. There are so many parts to proper healthcare, and even in a small urgent care, there are so many roles- from the front desk, to the medical assistant, to the scribe, to the PA/ Dr, to the administrators … I learned the importance of proper communication between roles, as well as mutual respect and support across everyone, in order to ensure proper care for each patient. In my role as a student, I was able to facilitate some of this communication and collaboration and help out especially when it got busy, which I really appreciated.