Primary Care Block

My school combines our 4 week rotations into “block” formation. For example, we have a Primary Care block, Emergency Medicine/Surgery block, Women’s Health/Pediatrics block, and Medicine block. My first block was Primary Care and that consists of Psychiatry, Family Medicine and an elective! Dermatology was my chosen elective as I’ve seriously considered choosing this specialty as a career choice in the future.

Books used for studying for EOR and rotation preparation: First Aid for Psychiatry Clerkship, Blueprints Family Medicine , Fitzpatrick’s Color Atlas and Synopsis for Clinical Dermatology

Psychiatry

Psychiatry, as a specialty, has always been interesting to me. We all know that mental health is a tough conversation in our society, so to see patients from all different backgrounds battling mental diseases was humbling and difficult at times. My rotation was with an academic institution’s inpatient consulting psychiatry service, as well as some pediatric psychiatry and adult outpatient clinic days.

Inpatient Psych had to be the most emotionally challenging of the three. We table rounded in the morning with the attending doc, a few 1st, 2nd, and 3rd year residents, a few medical students, and another PA student. We were all expected to have read up on the patients that were in our service and when the chance was given to us, we would present our patient to the rest of the table. After that, we split up in different small groups to go visit our patients and get an update on them, or visit new ones that were consulted in the last 12 hours or so. Being a part of a consulting service, in general, was interesting. Consults are expected to make a medical recommendation based off of seeing a patient, but the primary service taking care of them gets to decide if they agree with the recommendation or disagree and decide to continue going their own way. Throughout the month we saw quite a bit of suicidal ideation, patients with auditory and visual hallucinations, bipolar disorder, depression, and even schizophrenia.

My experience in outpatient pediatric psych was a good one. We worked alongside a public high school that provided psychiatrists to the school district in a clinic. We saw ADD/ADHD, autism spectrum disorder, suicidal ideation, depression, and even some oppositional defiance disorder borderline conduct disorder.

Last, but not least, was outpatient adult psych. This clinic was run by medical residents for an academic institution. This population of patients were mainly seen with depression and bipolar disorder. All in all, I enjoyed psychiatry, mainly inpatient over outpatient.

Family Medicine

My Family Medicine rotation was located at a large group private practice. There were around 6 physicians and 1 physician assistant on staff, all with their own patients. I like to compare Family Medicine to the ER, meaning you can truly get any complaint under the sun but usually without any acute/emergency like symptoms. We saw a lot of cough/cold, UTI, diabetes, hypertension, hyperlipidemia, well women exams, pediatric well child exams, annual physicals, and a lot more in between.

I enjoyed Family Medicine because of the aspect of continuity of care as well as forming real relationships with your patients, but I don’t see myself in this specialty for a long period of time – I think I would get bored.

Dermatology

I was VERY excited to have the opportunity to see Dermatology as my elective rotation. Not everyone gets a chance to see Derm in my program. The reason I think I have always been interested in Dermatology is the thought of being able to practice pure clinical medicine as well as throwing in some procedures (ED&C, cryotherapy, excisions and shave biopsies, etc) to break up some monotony that can occur with 8-5pm jobs.

This was another large private practice group, but instead of multiple physicians, there were multiple PAs and NPs (around six) and three physicians. Each provider had two or more medical assistants to interview, scribe, and help care for the patients being seen, which I thought was unique and very helpful for a busy busy practice.

We often saw and treated psoriasis, acne, warts, hidradenitis suppurativa, actinic keratosis, seborrheic keratosis, alopecia, eczema, melasma, rosacea, vitiligo and more. The practice even had a Mohs surgeon in the building to excise basal cell and squamous cell carcinomas. On top of all of that medical dermatology, adding in the cosmetic side with botox, kybella, filler, coolsculpting, different chemical peels and lasers, I really did have fun at this rotation! Mixing clinical with procedural as well as medical with cosmetic was very exciting and fulfilling.

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