For my mid-site evaluation, I presented an H&P on a patient with suspected cardiac chest pain and concerning ischemic changes on EKG. I was able to recognize red flag symptoms and educated the patient on the need for urgent evaluation in the emergency department for possible ACS, and that time matters in situations like this. Although the patient repeatedly refused transfer to the ED, we were able to have EMS come to the clinic to evaluate her, obtain a second EKG, and try to convince her as well. Ultimately, the patient continued to refuse transport, but this case reinforced the importance of recognizing red-flag symptoms and potentially life-threatening conditions, patient education, and appropriate documentation when a patient declines recommended care.

For my final site evaluation, I presented an H&P on a patient with uncomplicated cellulitis. We discussed the distinction between uncomplicated versus complicated cellulitis and how this guides antibiotic selection. This included reviewing factors such as immunocompromised status, recent hospitalizations, purulence, and recent antibiotic use. This case allowed me to demonstrate improved clinical reasoning and a more structured approach to both my assessment and management plan. I also presented a journal article discussing proposed risk factors and associations related to early-onset colorectal cancer, with emphasis on the rising incidence in younger adults. This led to a discussion on potential contributing lifestyle and metabolic factors and the implications for screening and risk assessment in primary care.

Throughout the rotation, I received helpful feedback on how to logically structure and approach my HPI, which I was able to apply at my final site evaluation visit. I learned how to write a concise and focused assessment without restating all elements of the HPI, and how to emphasize relevant findings based on the chief complaint. With feedback and what I have learned during the didactic year and this rotation, I feel more confident in my ability to produce a clear, well-organized HPI, provide effective patient education, and make sure that my HPI and presentations flow logically.