While I acknowledge that there are many patients who take their medications loyally and show up when they’re supposed to for blood work or checkups, I’m also noticing that several of the patients I’ve had so far have skipped up to 5 and 6 consecutive appointments over the last year, or they are walking around with severely uncontrolled hypertension or diabetes because they don’t take their medications. While I know that it’s not only here that many patients are noncompliant, it’s certainly my first time witnessing firsthand how devastating it can be for patients to go untreated.

Whether the cause of their nonadherence is economic, cultural or behavioral, or it’s simply because they don’t fully understand the pathology of their disease, it’s shocking to me how many people aren’t following through with screenings or taking the medications they desperately need, especially when it’s medication for perfectly treatable diseases.

This week I’ve taken some time to reflect on the problem of noncompliance and how universal its scope is, making me all the more want to stress the importance of following through with medical care for each patient I come into contact with on rotations.

For this rotation, I have been placed in an outpatient primary care office in North Philadelphia. So far, I have to say that it has been a nice transition from my last rotation, because they both happen to be outpatient primary care settings and I will likely be treating a lot of the same issues. However, even though both rotations involve following patients for their long-term medical care and dealing with everything under the sun, as we do in family medicine, I’ve already noticed that there will likely be differences when practicing medicine in an urban setting coming from a more rural one.

My previous rotation was in a very small town in the mountains with a very specific patient population, while the rotation I began this week is in a strictly urban setting with a largely Hispanic population. Aside from the fact that I’m excited to have the opportunity to speak what little Spanish I know, I am eager to observe the differences between the two rotations. I am curious about the different common disease processes that I’ll see between the two populations and about the differences in the philosophy of medicine depending on setting, if there are any.

I am actually very grateful that I’ll get the chance to see what primary care is like on both ends of the spectrum in terms of location, and am sure there is much to learn from experiencing them both.

With so many fields that have interested me, and with all that I’ve seen, I have decided to return to the site where I went for my emergency medicine rotation.

While I could see myself doing so many different things as a PA, there was something about the ER setting that seemed to just fit for me. Because of the fulfilling experience I had there, and because I was able to learn so many new skills hands-on with both doctors and PAs, I am very excited to return. Even though the elective rotation will only be four weeks instead of six this time, now that I have had a few more rotations with various experiences, I am hoping I will be able to gain even more knowledge than I did before.

As always, as soon as I entered the room, I asked him if it was all right with him that I see his daughter before the doctor. He agreed under the single condition that I had heard of and would be able to explain the particular hereditary condition his daughter happened to have on top of the everyday common cold that she was coming in for today.

Apparently, at an earlier visit, he had an experience with another student who became confused when he mentioned the particular condition. As soon as he told me the name of the disease, I realized that it just so happened to be one of our oral board topics from this summer. As he grilled me about the etiology, pathology, symptoms, signs and treatment of the disease, I felt surprisingly calm as I was able to answer everything correctly. It was strange feeling like I was being tested on the same thing all over again.

As a student, you realize very quickly that there is much you don’t know and much you still have to learn. This week, I found myself thankful not only that my school had prepared me well, but also that I was able to hold my own under the intimidation of someone who wasn’t satisfied with student care.

On a related and funny note, after coming out of the room and talking to a fellow student — who just so happened to be the same student from the parent’s prior experience — it turned out that she did know what the disease was, she just didn’t understand the man because he had spoken so quickly and was so intimidating.

To all those intimidating patients out there: Go a little easier on the students from now on, give them a chance. They may know more than you think.

Not only was I worried about a more rural feel, since I was only used to previous suburban or urban settings, but I also was unsure if I could feel satisfied in the office setting again after having so many great experiences working in the hospital environment. Despite my preconceived notions, I am actually feeling quite content and comfortable working in the office setting. I love feeling challenged each day as I encounter a lot more than I ever thought I would here.

As I mentioned before, despite my expectations of strictly managing certain things like hypertension or diabetes control, I’m also seeing a great deal of pediatrics, geriatrics, psychiatric management, and pain management. I am constantly looking things up and am seeing that I am again enjoying that “jack of all trades” appeal that this area of medicine has to offer.

I used to think that my attraction solely to the hospital setting was because I couldn’t find enough excitement in an office setting, but I’m starting to see that it’s not necessarily outpatient or inpatient care that matters to me most, but rather working in an area that encompasses a large variety of medical issues. Being on this rotation has surely has opened up my eyes to what direction I want to go into after graduation.

Not only does he cover a wider spectrum of care than many clinicians I’m used to, but he knows more about his patients than any doctor I’ve ever worked with. All he has to hear is the patient’s name, and he is able to tell me almost everything about their medical history. From witnessing how he takes his time to really listen to his patients and how well he knows them, I’ve been very impressed with the apparent connection he’s been able to establish with his patients over the years.

I have to say, I am already learning a great deal about following a patient medically in the long-term, and how a family practice setting functions. However, in the first week, I was more struck by learning the benefit of knowing your patients and establishing a lasting and trusting relationship. There is definitely something to be said for working in a setting where you know your patients intimately and are able to follow them all throughout their lives.

I look forward to taking a lot away from this rotation in terms of valuable medical knowledge, but also in learning about how to ultimately connect with my future patients.

After getting used to being in a hospital setting for my last three rotations and starting to get comfortable with seeing patients on the floor, I am excited to get back into primary care and learn what I can about managing patients on a more intimate level.

As much as I’ve loved all of my specialized rotations up to this point, I feel as though I am lacking an important foundation, because I haven’t had a family or internal medicine rotation yet. Over the next 6 weeks, I am hoping to learn a great deal about all of what primary care encompasses, and to harness some valuable primary care skills that I can carry over into whatever area I end up working in after graduation.

His advice centered on how even though we may have aced our way through PA school, and despite the fact that we’ll be graduating with a PA-C instead of PA-S after our name, long after we start working, we’ll still be students. He reminded us that each day we enter the workforce as a new grad, we will be learning and encountering patients or certain moments in our careers that will shape us as providers.

While he knows we are well aware that we aren’t expecting to know everything overnight once we start working, his advice was intended to remind us that no amount of studying or lectures can make up for raw experience in the healthcare workforce.

Thinking about the weight of responsibility we’ll have as new PAs certainly brings an aspect of fear or hesitancy when you are a student and everything seems so new. However, my preceptor had a good point today: He said that fear is not only a great motivator, but it is also necessary in some respects when working in medicine. It certainly isn’t the first time I’ve heard that a student or new provider with no fear and no doubts can be a really dangerous thing.

I think each moment invested in working toward a career as a healthcare provider helps us ultimately get to a comfortable place as future practicing PAs. I trust that over a good deal of time, with much more experience, and with so much coming our way in just the first phase of our career after graduation, we’ll all see that feeling at ease in our own skin as providers is a gradual, but eventual process.

As I learn from those who were students before me, one thing I’ve noticed is that whether we are talking surgery, cardiology, ER, you name it, they all seem to have the same things to say about how to handle rotations and how to feel ready for that fateful day we are set free into the working world. It seems like the most common thing I’m told is to be aggressive and get involved in as much as humanly possible. As a student, many times you really have to make an individual effort to jump in and do things on your own, but it seems like even the most simple of tasks has something valuable to teach you. Not only does taking this advice to heart make you as well rounded as can be as a new grad, but from what I’ve seen, the majority of the time, all you have to do as a student is ask, and someone is usually willing to teach you a new skill.

So far, I’ve personally been trying to get as much as I can out of each day, and each experience, taking full advantage of this year. I am hoping that by being aggressive with the hands-on education I have left, I will be able to say that I got the most out of my rotations as possible as I round the halfway point of my second year.

Today I left feeling so refreshed and hopeful that all is not forgotten from my days in class. After doing a consult with my team and discussing it with my preceptor today, everyone was discussing what the mystery diagnosis could be in our patient. As the student, I politely listened to what everyone thought it could be, and for what seemed like forever, I went over all I knew about the situation in my head. A tiny side not from a lecture we had in what seems like months ago kept popping into my head, so I when the time was right, I made a suggestion.

While appreciated, the conversation was redirected after having discounted the probability of the cause I was thinking about in this particular case. Still, at the end of the day, after the labs were in, I ended up having the correct diagnosis.

As a PA student, you get used to feeling like there is so much that you don’t know, and that you have a long way to go until you are able to contribute. Today, I have to say, I left feeling hopeful that even though there will be many more moments where I feel clueless, and even though I know I have a long way to go in this journey, it only takes recalling one tiny detail to feel optimistic about everything coming into place soon enough.

Today I left with a smile, happy that I spoke up, and that I was able to contribute to the mentors I look up to.

The familiar rush I felt in the ER each time I got to physically do something for a patient, no matter how simple, or when I had the opportunity to learn a new skill, has resurfaced on this rotation. Despite the fact that I am surprised at how much I love working with the surgical team so far, I am utterly exhausted at the end of each long day.

The first week of surgery was a whirlwind of experiences and late nights, and the schedule for this week is even busier. I am learning more than I have on any rotation yet so far, and with two excellent preceptors, I am seeing every aspect of surgery. In our practice, however, on top of the typical responsibilities of a general surgery team, the doctor and PA I am working with have recently taken on more patients from a local long-term care facility in order to provide advanced wound care. While this means that I get to see innovating areas of treatment like hyperbaric medicine and wound care for things like stage 4 decubitus ulcers, it also means we are very busy bees.

As I try to keep up with the fast paced world of surgery, and I notice a trend for myself in terms of what types of jobs I am leaning towards after I graduate, I’m feeling lucky again to be in PA school this week. Being impressed and entirely exhausted all at the same time, I can honestly say at this stage of my life, I wouldn’t want to have it any other way.

The majority of my rotations up to this point, with the exception of the C-sections I assisted in while on my OB-GYN rotation, have been medically focused. While I only have minimal experience scrubbing in and seeing how things work in the OR, I feel ready to dive into learning about the world of surgery.

From what I’ve heard, learning from a surgical perspective can be a little different from the medical perspective I’ve been used to. Despite this, I am geared up to start reviewing the general procedures I will be seeing each day, and more importantly, studying much of the anatomy I’ve forgotten since my first months of PA school. I am hoping this rotation gives me some good insight into what general surgery encompasses, as well as the necessary pre-op and post-op care for many of the common procedures I’ll see. Something tells me that while assigned to surgery for the next 6 weeks, I will be doing more studying than usual in order to be as prepared as possible to get the most out of each OR experience.

Everyone in my class had the opportunity today to share our different experiences on rotations and discuss how hard we’ve all been working. Our professors took the time to remind us in lecture of how quickly the clinical year is going and how, before we know it, we’ll all be sitting at graduation this summer. It’s truly hard to believe that we are already done with three clinical rotations.

With three down and five to go, I am looking forward to a little break to recharge my batteries. Although I’m sure I will be spending a good amount of time preparing and reading for my surgery rotation, which begins right after the New Year, I look forward to spending some quality time at home with the family and to catching up on some much needed sleep.

In all seriousness, this week, as I am approaching the end of yet another rotation, I’ve had the pleasure this week of bonding with many of my patients on such a different level than I’m used to. One of the main reasons why I always knew I wanted to work in medicine, and more specifically closely with people each day, was very much due to the chance we get as clinicians to form a raw connection to our patients, and more so, the ability to have a positive impact on their life in some way, many times at a time when they need guidance most.

The experience of an OB-GYN rotation as hands-on as this one is teaching me so much about just how important the connection we establish with our patients can be. While the relationship we form with our patients can be immensely important in all fields of medicine, I’ve been able to see the beauty of sharing such an important moment with a patient, in this case the experience of childbirth, here in labor and delivery.

As I approach an emotional time of my year, I’m so appreciative for the intimate connection I’ve been able to make with several of the patients I’ve had the pleasure of meeting here. I can only hope that as my year continues, I have more enlightening moments that remind me why I was so intrigued by a career in medicine in the first place.

This week I’m learning the value of “being thrown into the fire” so to speak, as we often are as PA students in our second year.

The rotation I am on now is notorious for being overwhelming, due not only to the great expectations of the students performance here, but also because of the sometimes 80 hour weeks, and lack of direction in terms of what to do and how to do it once you get here. In order to survive, students must take responsibility to figure things out for themselves, without asking too many questions. If students decide to be aggressive and learn how to get things done properly by trying it on their own, it’s easy to adjust to a quick, efficient routine. However, if they instead find themselves too intimidated by the fast pace and constant criticism, then it’s easy to fall by the wayside in terms of learning.

Now in my 4^th week, after many challenging days myself, I’m able to say that now I’m comfortable. I have been able to learn so much in such a little amount of time, but only after taking the initiative to learn hands on, as uncomfortable as it may have been in my first few days.  As I teach the new students now and as they struggle to try to make it through the chaos of their first week, I am actually thankful for my own similar and very recent experiences. The stress of my first week here actually opened up an opportunity for me to jump right in and figure everything out as I went along, which in my opinion, sometimes is the best way to learn.

I think it’s pretty common to feel overwhelmed at times in certain new situations throughout the clinical year. As rotations are one long year of new situations, students find out quickly the best way to deal with adjusting to a new and challenging environment. Many students realize, as I know I have, that there will be moments this year when it’s normal to feel like you know nothing at all. In truth, we all learn a little more each day, but a great factor in that is how much one as a student is willing to do. I know that for me, it became obvious quickly that one can benefit much more from being proactive in learning or by taking initiative to gain as much as possible from each experience, especially when there is no one to spoon feed it to you.