1) Interpersonal challenges and how you addressed them

Some of the interpersonal challenges that encountered during the LTC rotation included obtaining a complete and through history. This was complicated by the fact that many of the patients were either delirious or had some form of dementia. Even trying to fill in the blanks by utilizing the transfer records was not helpful in certain circumstances. An example of this was when I had a patient that was admitted to the hospital for seizures suspected secondary to a hyperglycemic state, I was unable to obtain certain crucial parts of the history such as the past medical history, past surgical history, and even the reason as to why the patient was intubated after she had the seizure. I believe that this can be rectified by utilizing the family members that are close to the patient or even the patient’s health care proxy to obtain the complete history or even verify the information I had obtained through the patient/transfer records.

 

2) Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

One of the skills which was pointed out to me by my preceptor was the ability to formulate a treatment plan on the spot. This became apparent to me when I was asked by the preceptor about a particular patient’s treatment course. I believe that I can improve upon this by studying more up on the treatment plans and thinking about the hospital course if a certain patient comes in with that disease I am studying. I can also do this with every case question that I can come across.

 

3)  What was a memorable patient or experience that I’ll carry with me? 

One of the most memorable patients that I have encountered during my time on LTC was a patient that was difficult to deal with. Every staff member that encountered this patient was knew this patient as being a difficult patient to deal with, even the simplest questions asked by staff were met with a bunch of complaints and noncompliance. It wasn’t until I was asked to go see this patient that I also agreed that the patient was difficult to deal with and soon after sitting and talking to the patient did I realize that the patient was only complaining because no one was interested in listening and letting the patient vent. This made me realize that sometimes elderly patients do not need more medications but rather just someone to listen to them. I even tried this technique with some other patients and instead of telling them what they need to do, I heard them out their complaints and concerns which made them feel a lot better, less worried, and more receptive to the provider’s suggestions.

 

4) What do you want to improve on for the following rotations? What is your action plan to accomplish that?

One of the things I would like to improve upon is the ability to function independently in terms of interviewing and examining patients as well as coming up with proper treatment plans. I believe that when I am not supervised, I get more nervous and forget some of the most basic stuff. I plan on changing this by being confident and trusting in what I have studied. Additionally, I can improve upon this by asking to present the patient and the treatment plan to my next preceptors.