Clinical Year: Family Medicine Rotation for PA Students

I started my clinical year in family medicine, and personally it was a great place to begin. I was at a private practice with one physician who has been practicing in the area for years. He is close to retirement, so he only saw patients in the mornings, roughly 8 to 12 each day. I worried at first that I would not see enough patients to get good experience, but that was not the case at all. We usually saw 12-15 patients a day, and over my 4 weeks I felt like I got plenty of exposure to family medicine.

My first day, I was a bundle of nerves. I was walking into a brand new place where I did not know a soul, and it was my very first rotation. The nurses showed me where to put my things and I met the doctor in his office. He was nice but quiet with a fairly flat affect, so I still had no idea what he would want me to do. Once patients started arriving, I got thrown to the wolves, which ended up being a good thing. I would see the patient first, then come back and present to him, and his questions pushed me to think about what I should be asking and considering.

Over my 4 weeks I saw a wide variety of patients and conditions. Here are some of the main ones:

• Yearly well-checks and physicals: lots of counseling here on diet, social habits, medications, and vital signs. It is a great time to practice your physical exam, so use the opportunity if you have time.

• Hypertension (high blood pressure): if the nurse gets a high reading, recheck it manually in the room, possibly in both arms, before reporting to the physician, because they will likely ask you to do this anyway.

• Hyperlipidemia (high cholesterol): a fatty meal the day before labs is not the reason cholesterol is high, though it may bump triglycerides.

• Diabetes: tough to control and heavy on counseling. If you can do an endocrinology rotation, I would recommend it, because uncontrolled diabetes can lead to some scary outcomes.

• Shingles (herpes zoster): easy to miss early, and it still tricks me sometimes. The biggest clue is that it appears on only one side of the body, so if symptoms follow a single unilateral dermatome, consider shingles.

I had my first encounter with a drug seeker on this rotation, and I felt incredibly naive reporting back to my preceptor. A patient gave me an intense story about anxiety, trouble focusing at work, and back pain, and when I relayed all of it, my preceptor simply said, "Ah, the trifecta." I learned that patients sometimes want not just pain medication, but anxiety and ADHD medications too, and that you have to stay a little skeptical, which is sad but real.

I also had a scary experience with an uncontrolled diabetic patient who looked flushed and unwell, had been having diarrhea for about 2 weeks, and was running blood sugars consistently in the 300 range. He was heading toward hyperosmolar hyperglycemic syndrome and needed the ER. I stepped out to grab the doctor and heard a loud noise as the patient passed out and fell back on the table. We called an ambulance for fluids, and it taught me to never leave a patient's room if they may not be stable. Other lessons: present your differential and plan confidently, do not laugh at how patients describe things, and work on your shocked face so you stay neutral no matter what you see.

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Since this was my first rotation, I spent a lot of time figuring out the best study resources. I leaned on my PANCE review book quite a bit, which I think every PA student should own, but sometimes it did not have as much specific detail as I wanted. To fill the gaps, I also used Step Up to Medicine, and I really like that book for both family medicine and internal medicine.

Overall, I really liked family medicine. I love that you get to know your patients well and follow them closely over time. The one thing I did not love was seeing the sick visits, like patients with the flu or colds, though I saw fewer of those because it was August. If you are heading into your clinical year, family medicine is a solid, well-rounded place to build your foundation.

Family medicine is a strong foundation for your clinical year, building both your clinical reasoning and your people skills. Go in ready to present, stay curious, and lean on solid resources. If you want guidance preparing for PA school and the road to clinical rotations, we are here to help every step of the way.