Rotation 2 for me is primary care in a private clinic in the “Chinatown” of Brooklyn and the first week and a half at my new rotation site have been rocky. Going in, I knew primary care was going to be different from emergency medicine but I didn’t realize how different.
There have been a couple obstacles that I’ve had to figure out how to handle, one being my preceptor not being at the clinic to teach me sometimes. For example, my preceptor did not show up the first two days I went to the clinic. Because he didn’t show up, it was hard to know what I was even supposed to do. There’s another guy at the clinic that sees patients but he’s not my preceptor and his approach to seeing patients is different to what I was used to in the ED and is also different to my preceptor’s, which I found out on the third day of the rotation. So after two days of learning how this person saw patients and documented patient visits, I had to mentally switch processes under the tutelage of my preceptor. My assigned hours start at 10 a.m. but sometimes my preceptor doesn’t show up until the afternoon, so there have been days where in the middle of the day I switch methods to match the person I’m working for.
Another issue has been a language barrier. On some days I’m thankful I wrote down I could converse in Chinese when we signed up for rotations back in February, but on many days, especially at this clinic, I wonder why I did that to myself. Many of the patients, especially if they’re seeing the other person at the clinic, speak a different dialect of Chinese that I cannot understand, so oftentimes I stand to the side lost in translation. This makes it very difficult to follow the conversation and visit for obvious reasons, and it also makes it very difficult to write the progress note for the patient visit. There have been days where many patients in a row speak the foreign dialect and then when I’m trying to catch up on notes I have to stop every sentence to double check with the person who actually spoke to the patient.
Many times I have had a hard time interviewing patients because they seem to not trust me. Just yesterday, I was reviewing a blood test report with a patient and also going over his past medical history and everything I told him was medically sound but he didn’t seem to buy what I was telling him. When the other person came into the exam room and repeated everything I told the patient, he readily received the information. After the person explained everything, the patient told him he liked chatting with him. The person I work with told me many times Chinese people don’t trust me because I look young and when I smile I look like a kid. I kind of took offense to this initially (internally, of course) though I admit I look young. But in my opinion, it’s not something I can change, and I never had that problem at the ED in my past rotation. So now I’ve become more conscious of how I carry myself and also how I present the medical information to patients.
Clinically the greatest challenge has been learning how to turn medical information into practical and applicable knowledge for the patient. For example, when I see that an ultrasound report shows ovarian cysts, I understand what that means. But patients don’t care so much about the pathology—they want to know is it dangerous, is there any medication for it, does it require surgery, etc. In the classroom we didn’t really learn how to explain findings to patients and how to navigate treatment/management plans, and my preceptor assumes I already know how to practice on my own, so in my mind I’m going “Help! I don’t know what to do!” while I plaster on my professional face and try to say something that makes sense and is helpful.
In the ED we focused on very acute illnesses but in primary care we focus a lot on chronic illnesses and preventing diseases. Therefore communicating with the patient is paramount for patient compliance and cooperation, which leads to their wellbeing.
Thankfully my preceptor enjoys teaching, and by observing I’ve gotten some ideas of how to talk to patients. I still have a lot to learn—not just to solidify my medical knowledge, but also to become skilled at asking the right questions, motivational interviewing, and formulating the best plan of action for the patient.