This is my second site visit that was conducted via a webcam and not in person. Having a bit more experience with webcam site evaluations since my psych rotation, I had no technical difficulties and everything ran smoothly. Both site evaluations were done via “Zoom” and I received great feedback from professor Sajid Mohamed.

In total we had to do 8 focused H&Ps, 4 for our first evaluation and the other 4 for our second evaluation. For my first evaluation I presented Mr. A who was 52 years old and came in with a chief complaint of cough that had been going on for 3 days. Mr. A described the cough as non-productive but did report some mild chest pain which was associated with the cough. He also reported burning sensation in his chest and throat only when drinking alcohol or eating spicy food. On physical exam he had stable vital signs and a benign physical exam with the exception of some mild chest pain when palpating. EKG was done for Mr. A to rule out any acute cardiac issues and was referred to cardiology for further cardiac workup. Top of my DDX was GERD and was referred to GI for a  24hr ambulatory pH monitoring while at the same time started the pt on omeprazole, 20 mg orally once a day for 4 weeks and see if he gets any better. Pt was also on lisinopril as he had a history of HTN, so we decided to discontinue lisinopril as ACEi are associated with cough and instead start him on losartan 50 mg orally once a day and advised him to follow up in 4 weeks. For this particular H&P, professor Sajid suggested to also add COVID-19 as a potential diagnosis as it should’ve be rule out in a person with a cough, especially during the current pandemic that we are in right now. For my second site evaluation I presented Mr. H who came in for a post hospitalization follow up. He is a current smoker with a pack year of 15 and two weeks ago, Mr. H had an episode of transient ischemic attack and was hospitalized for 2 days. TIA resolved itself within 15 mins with no complications and patient took 2 aspirin pills (81mg) before EMS came in. Today patient reports no symptoms and physical exam was benign and the patient scored a 30/30 on the mini-mental exam. A CT scan of the chest was ordered since our patient has been a smoker for 30 years and is still a smoker. Smoking cessation consultation. Nicotine patch gum was offered and we asked the patient if he wanted to also start on Chantix if he didn’t like the gum. An ABCD2 score was also preformed and the patient scored a 3 which means currently he has a 3.1% of 90-day stroke risk. We also consulted patient on the importance of a healthy diet and exercise to prevent future strokes or TIAs. I received great feedback for my H&Ps from professor Sajid especially for the “plan” section of the H&P. Another suggestion that professor Sajid made was that since this was a focused H&P, my physical exam and ROS should be straight to the point and keep it as pertinent as possible.

The article I selected to present to my site-evaluator was a systematic review which was published in 2017 with the title “Seasonal influenza vaccination in patients with COPD”. I selected this article because it was a systematic review with a very large population size of 174,145 patients and it was relevant to my ambulatory care rotation as we get a lot of pts with COPD who have questions about the seasonal influenza vaccination. This article concluded that seasonal influenza vaccination does in fact help in reducing exacerbations in pts with COPD and should be recommended to everyone. Professor Sajid did agree with their conclusion and further explained that the same thing might also happen when we eventually get a vaccine for COVID-19. COVID- 19 vaccination could also be beneficial to pts with COPD and help reduce exacerbation episodes.

For my 10 pharm cards, I tried to select all drugs that I saw the most during my ambulatory care rotation. Some of the drugs I selected were alpha blockers such as terazosin for BPH symptoms, SSRI for depression or anxiety and also gabapentin for neuropathic pain.

Overall, this was a great experience and I received very helpful tips and comments from my site-evaluator.

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