During my site evaluations for this rotation, I presented two cases that I found to be interesting and very relevant to my family medicine rotation. For my first H&P, I discussed an older female patient with a history of hypertension, hyperlipidemia, and history of cholelithiasis who presented with a complaint of abdominal pain that began one week ago. Given her history and symptoms of exacerbation of pain after meals, her findings were most consistent with biliary colic or acute cholelithiasis. Physical exam was notable for epigastric and right upper quadrant tenderness, without guarding or rebound and her vitals were hemodynamically stable. We obtained basic labs and prescribed omeprazole for symptomatic relief. We also gave referrals for an abdominal ultrasound and general surgery for further evaluation. Although this was a general and vague presentation of abdominal pain, the patient’s history and relevant symptoms made the diagnosis easier to interpret. Additionally, we also focused on symptomatic and long term management, which emphasizes the importance of preventative care in outpatient settings.  

For my final site evaluation, I presented my second H&P on a female patient with a history of hypertension, hyperlipidemia, and diabetes who presented with a cough and sore throat that has been going on for 4 days. On physical exam, there were diffuse decreased breath sounds and wheezing heard throughout bilateral lung fields. Congestion of the nasal mucosa was noted along with mild erythema of the oropharynx. We obtained covid and throat swab, started the patient on DuoNebs in office with improvement in wheezing and overall breathing, and prescribed the patient with benzonatate, an albuterol inhaler, and Zithromax. Viral upper respiratory infections are a common presentation in family medicine and the acute management depends on many factors, such as age, clinical presentation, and the presence or absence of comorbidities. This case taught me how to manage these acute conditions before it progresses and worsens for the patient.  

Overall, I received good feedback on my cases in areas where I can improve on and continue doing well. I received feedback on enhancing my patient education, especially considering chronic conditions, such as hypertension or diabetes. Although patients may present with acute cases, their chronic conditions still need to be addressed which reinforces the importance of primary care.