For this rotation, I had 2 virtual site visits with Professor Rachwalski. For my first site visit, I presented 2 H&P’s and for the second one I presented 1 H&P and an article related to it.

The first patient I presented was a woman who came in with sudden onset of abdominal pain, who also had creamy white vaginal discharge. I discussed how seeing the discharge on pelvic exam changed our differential from a simple muscle strain to considering more GYN issues, such STI, ovarian torsion, TOA, or a cyst.

The next patient I presented was a man who had not seen a dr in 40 years who came in with a vague complaint of back pain, who, on further questioning, revealed numerous other symptoms including frequent diarrhea. A hemoglobin of 4 upon getting labs combined with his other symptoms led us to suspect cancer as higher up on the differential, and admit him for immediate treatment and further workup.

The third patient I presented was one who came in with chest pain and palpitations. Upon further examination, he revealed that he had been extra anxious lately, which led us to change our differentials more towards a psychiatric issue. I then presented an article on likelihood of PE after phlebectomy, since he had undergone a recent phelebectomy a month ago for varicose veins, and we kept PE on our differential because of that.

I purposely chose these 3 cases to present because they were cases in which, at least to me, the proper diagnosis did not jump out right away, and I had to do a little more digging and questioning to get better clues towards the proper diagnosis. Though some diagnoses are more straightforward, I have found that in medicine in general, and especially in EM, proper general and focused questioning, such as use of OLDCARTS, pertinent positives/negatives, etc, is very important in coming to a proper diagnosis and treating patients effectively.

Professor Rachwalski was very helpful and provided constructive feedback, such as guiding me on how to focus my ROS and PE more in the EM setting. He also gave me positive feedback on what I did well, and gave me general guidance on EM which I greatly appreciated. Overall, I gained a lot from the 2 site visits!