Working with veterans was such a great experience. I loved being able to listen to the their stories about their times in war. Working at the VA is different from other hospitals. First, working with a patient population that is dominant in elderly males rather than a mix of male and females was quite the change. I saw more inguinal hernias during my time there. You are also working with patients that have sacrificed their time and lives for our country. A sacrifice many of us haven’t made. Many patients would talk more about their times in war more than their medical problems. I am still learning even now how I can give the appropriate time to listen to the patient’s stories, but get a history and physical done in an appropriate amount of time. As always, some patients will need more time than others. Some patients just want and need someone to talk to. Sometimes, listening is the best dose of “medicine” you can give to your patient.

I know it has been so long since I have updated. My apologies to the ones that check this blog out or have been following me. I have been busy with rotations, and then advanced didactic year is just around the corner! I wish I could make comments on every rotation, but I guess it would be easier to answer specific questions. I have almost completed 8 rotations..Psychiatry, Family Medicine, Pediatrics, Dermatology, Surgery, Emergency Medicine, Internal Medicine, and OBGYN. My most favorite rotations have been Derm, Surgery, and ER. I have realized I love doing procedures. I love suturing lacerations, I just love working with the human body. It has always been a goal of mine to make the patient feel at ease, and make them say, "wow, that was a great experience with a PA." I graduate in December, and will be done with my OBGYN rotation at the end of August. I know once advanced didactic starts, I will be in full on panic mode. Loans, Applying for jobs, PANCE preparation, etc. The list goes on and on. Not to mention writing my paper for my masters. :) I will try to make it my goal to post once or twice a week from here on out. I love helping people who have any questions. Feel free to click on the "Contact me" link and it will send an email my way.

I often wasn’t allowed in cosmetic dermatology patient’s rooms. “They are self conscious,” the doctor would claim. If a patient was having Botox done, or laser resurfacing, they were often embarrassed about their conditions. The PA would often tell me that people who suffered with skin conditions such as psoriasis, took their diseases harder than those with diabetes or hypertension. “You can see the their disease physically with your own eyes. Normally, people on the outside can’t see the physical effects of hypertension or other diseases.” While with the dermatology patients, it was my goal to make these patients feel as comfortable as possible. I would talk to them about their disease, and educate them. They also felt more at ease when you were able to touch their skin condition without being afraid. It’s amazing what the simple human touch can do to a patient’s outlook of their skin condition and the way it eases their discomfort.

My first patient at SJC hospital was an 8 year old male who was wheel chair bound. I was nervous because I have always had adult and adolescent patients. He seemed more fragile to me. He had a tracheostomy and a breathing machine because he was born without his left lung. He also had a gastric tube. These were two things I was not used to. “Good morning, my name is Ashleigh. I am the physician assistant student,” I say to the mother. I look down to the young boy and say “good morning” with a smile not even sure if he can even speak. He holds his arm out to shake my hand and greets me with a “Hello!” and a bright smile. After taking a history from his mother, it was now time to do a physical exam. I examined his head, eyes, ears, nose, and neck with no problem. I knew pulmonary, cardiac, and abdomen were going to be harder for me. He was fragile in my eyes and I felt he was too delicate to touch. I didn’t want to have him over exert himself during auscultation and I surely didn’t want to palpate his abdomen once I saw he had a gastric tube. “I have to press on your belly now okay? You tell me if it tickles or it hurts ok buddy?” He looks at his mom with weary eyes that made me more nervous. A giggle leaves his mouth and I start to become more at ease. I palpate more, “Ow, that hurts.” My first pediatric patient wouldn’t be my last pediatric patient to say “ow” or to cry. During my rotation at SJC, I would have many more children that would cry out in pain. All of these patients became fragile and delicate to touch in my time of care. In school, we learn to do a pediatric physical exam but you have to find your own flow of how you want to do your physical exam. Pediatric patients are different. They aren’t like adults, they don’t stay calm (most of the time), and they don’t understand that it will all be over in a mere few minutes. As delicate as they seem, a proper history and physical is critical for their health and for a correct diagnosis. It was hard to overcome the thought that I was causing them more stress and pain. It’s also not easy to hear heart sounds over a child that’s crying. Focusing in on those heart sounds or breath sounds, and performing a quick and thorough physical exam was something I had to adapt to. It’s not something that I mastered overnight, but something I gained experience in as the rotation progressed.

For those that have tried to use the "Contact Me" Link in my blog, it probably hasn't been working for you. I really apologize!! I have now updated it, and it should be working again if you have any questions! :) Depending on the browser you use, it should come up with some silly words you have to type in that are case sensitive. If you don't see those silly words, it won't work for you. You can always leave a comment with your email and I will get back to you that way also. Thanks everyone for reading!

Im in my second rotation now. I am currently doing family medicine at a FL health clinic in a rural area.

My patients are very sick, poor, and most of the time have no insurance, or very little money. I mostly see patients that have diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol), depression, and other various diseases.

Many patients will come in suffering from many issues, it is my job to sort out the most important ones. I wish I could spend an hour with every patient I see, but sadly it is not realistic when you have a schedule of 30+ patients.

The walmart and publix drug lists are becoming my best friend. If I need to prescribe anything, I try to go off the list so patients get their meds for free, 4$ or 10$. For you future students on rotation, put a list of these in your pocket. They are very useful and they are not just for the patients that have no insurance, everyone should put them to use.

I also recommend that you download some applications for your droid or Iphone. Some good ones are medscape, epocrates, ICD9 codes. Make sure you ask your preceptor in advance to use your phone. Some dont mind, and some mind a lot. I use medscape mostly especially for drug dosages. I'm getting to the point though where I keep using the same drugs over and over and I don't need the dosages at all...thank goodness! :)

I hope everyone is enjoying the fall and everyone is counting their blessings. God is good...God is love, hope, and encouragement.