This rotation was a very interesting experience. It was my 8th rotation, and the first one where I really got experience with one specific area in multiple settings- including outpatient (clinic), inpatient, emergency room (consults), and surgery. I enjoyed being able to rotate “horizontally” in one field of medicine but in multiple areas. I also liked that sometimes I was able to follow up with the same patients and care for them in multiple settings (For example, I was in a few deliveries and then checked in on the patients in post-partum, I scrubbed in to a c-section and was there for her follow up appointment in clinic.)

Since I got the opportunity to work with many different PA’s, Doctors, and midwives throughout my rotation, I was exposed to different treatment techniques. There were many patients who did not speak english, and providers usually used interpreters to communicate. I noticed that some providers spoke directly to the patient through the interpreter, and some spoke in third person, as if they were speaking to to the interpreter and not to the patient. I usually speak directly to the patient even when using an interpreter, and when seeing both treatment strategies, I recognized how important that is. The ones who spoke in third person definitely did not establish the same level of rapport or make the patient feel as comfortable as the ones who spoke directly to the patient, albeit through an interpreter. I am happy that I was able to see both methods and recognize the stark difference and the importance of speaking directly and doing whatever you can to make your patient feel comfortable and cared for, especially when they speak another language, which already may make them less comfortable.

Some types of patients I found challenging during this rotation were patients who were not open and did not tell the full truth when asked about their history. This could be due to several reasons, including simple misunderstandings, or often discomfort or embarrassment. Simple misunderstandings were easier to fix by just rephrasing questions in a different way. For example, often when asking patients how many times they had been pregnant, they would only include amount of times they gave birth, so I would clearly ask how many miscarriages or abortions to clarify the total number of times they were pregnant. Similarly, when asking about term vs preterm labor, sometimes patients did not understand the difference, so it was crucial to clearly ask at how many weeks they had their baby. Patients who intentionally hid the truth were more difficult. Since OBGYN is a more “private” and uncomfortable field of medicine, patients were sometimes embarassed to share their full symptoms or full history (big ones include last time of sexual activity, history of STI’s or number of sexual partners, since patients often do not want to share these private details). I learned that the best way to deal with this is, BEFORE asking all these questions, to establish a good rapport with the patients and make them feel comfortable and cared for, which will make it more likely that they will be willing to share information with you. It is also important to reassure patients that there is no judgment and this information being shared honestly is necessary in order to enable us to treat them in the best way possible. If none of that works, all we can do is act based off of what the patient says in addition to old notes if there are any, and try our best to help them with whatever information we have.

A very memorable patient I had was on my first night on GYN call. It was about 3 am when I got called to go provide a consult in the ED for a patient who came in with abdominal pain. I came into the ED to find her pacing around the area in pain and panicking that she was just told that she was pregnant. Looking at her, I thought she looked pretty pregnant, but she said that her LMP was 3 months ago and she had irregular periods, so she had no reason to believe that she was pregnant. After examining her, we determined that she was in pain since she was having contractions, and she was sent to the L&D floor, where she was found to be 37 weeks pregnant. I visited her there where she delivered a healthy baby 2 days later. Other than this being a unique and crazy experience, I learned a lot through it. Firstly, I learned that it is always necessary to keep every option on your differential, and act not only based off of information the patient tells you, but also other information you are able to see. For example, the patient told me she was 3 months pregnant, so I did not really have “contractions of labor” on my differential at first, but I could tell that she looked bigger, and I should have broadened my thought process. Additionally, I learned that as providers, we need to put our own thoughts and judgment aside and be there for the patient. When I approached this patient, she was panicking and shocked to hear of a pregnancy diagnosis, and all of the staff surrounding her were not giving her any attention and calling her crazy. I could have done the same, stating- “how are you so shocked from this news? You clearly look pregnant and you haven’t had a period in at least a few months.” But as a provider, that was not my job. So I showed the patient care and concern, empathized with her, and did my best to calm her down and help her accept this news. I established a good rapport with her by actually caring about her and looking past the “craziness,” and through her stress and anxiety, she was very happy to see me when I visited her later before she gave birth. 

During this rotation, I learned that I LOVE OB. My week on the labor and delivery floor was my favorite week of all of rotations thus far (even though it was an overnight shift and I generally am not happy on little sleep.) The opportunity to be there and help women bring life into this world is truly an incredible and special opportunity. I loved being able to help women throughout the prenatal process, as well as being there and supporting while watching the miracle of life occur before my eyes. I did not like the GYN part as much, though that too I liked more than I thought I would. I would love the opportunity to find a job as a PA focused on OB. I am not sure if that exists, but now I know that I want to look out for it. 

Overall, I learned a lot this rotation and appreciate the experience.