I was given the amazing opportunity to have my Emergency Room Rotation at Queens Hospital Center. There was so much I got to see in this rotation and I am so grateful for everyone and thing that helped to enhance my learning experience. The faculty at Queens Hospital Center are truly some of the sweetest, most involved providers that I have encountered, and they seemed to have taken a real interest in teaching me their ways, which I highly appreciated. With all this being said, I also had my downfalls that I will discuss in detail below. Some of these downfalls include but are not limited to, changing my method of thinking, my lack of confidence, my struggles in preforming procedures and finally interactions with my preceptors. This will be a rotation that I will remember for many years to come and I highly recommend this site to everyone that is interested in emergency medicine.

One of the hardest adaptations that I had to encounter in the emergency room was skewing away from a diagnosis and thinking of what could kill the patient first. This is not the typical method, at least from my experience, that is used in other parts of medicine, such as family medicine. Normally, every rotation that I have had thus far, I have been trained to think of the most likely diagnosis and then come up with other differentials that are also possible, but that was not how medicine is practiced in the emergency room. You must think of what could kill the patient first or could cause permanent disability and once you have ruled out every possible cause that excludes those factors, then you can think about differentials. For example, a patient comes in hypertensive urgency, completely asymptomatic, you must rule out a number of possible debilitating diagnoses before flagging the patient as non-acute. One of the bad habits that I had picked up from my rotations is asking certain questions just because it is required. For example, for family medicine and urgent care, it was require for me to ask every patient if they were having chest pain, shortness of breath, abdominal pain, headaches, or any other complaints, even if they came for something completely irrelevant. Even though, yes of course, when you ask those questions, you want to make sure that the patient does not have any deadly complaints, but you tend to forget the significance of asking those questions, and I believe that is what happened to me in the rotation. I was just asking questions for the hell of it, and I was not clinically correlating the answers. Most of the time, the patient would deny symptoms, but even them denying symptoms is significant clinically because so much more could be ruled out or in. One of my preceptors for the rotation stressed the importance of asking questions to rule in or out diagnosis and just not asking questions because of habit. I really appreciated the advice and I tried to use it as much as I could throughout my rotation, and I do believe that it benefited me.

The emergency room is supposed to be a rotation where students are drowning in procedures, in a good way of course. I feel like I did not fully appreciate this opportunity and continually gave my chance to preform procedures to other students. I need to stop doing that, I am so annoying. I guess the stem of the problem rooted from when I encountered a very nice gentleman from Stony Brook who was also a physician assistant student. He just seemed so confident in everything he was doing and was also so charming and nice. There was nothing wrong with him, and I think that was the problem. He naturally got along with the faculty and would dig out procedures while I would stay in my little corner afraid that I might be in someone’s way. I was great at interviewing patients and coming up with diagnoses, but when it came to procedures I was definitely lacking the confidence I needed. I will further discuss my problem with confidence later but that was exactly it. I found myself struggling to preform procedures as I preformed them and I could not for the life of me get an intravenous line. I am so disappointed in myself because on of my goals in school was to be able to do everything a nurse could do, so there would not be delays in patient care. I understand it nurses are very busy and sometimes it takes a couple of hours before they can get to a patient, but they try their best. One of the things that could be done to improve and speed up patient care is, if the provider has time, take procedures, such as placing IV’s and administrating medication into their own hands, so the patient does not feel neglected and results could be seen sooner than expected. Unfortunately, this was a sad ending on my part, and I wish I was more confident in myself. I spoke to many different physician assistants through out my rotation and they all had encouraging words, such as, “I learned everything I know on the job, nothing as a student”, or “I didn’t get it until my fifth time”, but I just wish I could have done more.

Specific procedures that I was horrific at, was first and foremost, IV placement. Out of the twenty plus times I had tried to insert an IV, I was successful once, which is very sad. I know I should not beat myself up over it, but still, as simple as it is, it is very necessary to be proficient at it. Other procedures that I was not so amazing at was abscess drainage. There is nothing difficult about draining and abscess, but I realized that I was not applying enough pressure while preforming the drainage because I was afraid of hurting the patient. Like, I know I have the strength inside of me to do it, I go the gym, lift more weights than most girls do, but I was just afraid of causing the patient pain and I think that was my ultimate down fall. These past two paragraphs is a combination of both of my weaknesses in procedures and lack of confidence. In terms of the IV’s I really could not do much because it was highly dependent how patient the nurse was, but I did find much success in procedures where I had certain preceptors. I notice that I work much better when I am alone and not when someone is breathing down my neck. I just need someone to show it to me once, and I should be able to ask all the questions that will help me understand what to do in different situations, but I work much better once I am alone. I have been told that many times, and I think it will help me to find a career where I have autonomy and am able to treat my patients with confidence because I know I am working in their best interest.

While at Queens Hospital, students are assigned a new preceptor almost every day, which was exciting and fun at times, but also annoying because it would be difficult for me to understand what each provider expected from me. For example, there were some providers that would want a complete history and physical, with a large list of differentials and reasons why I thought my diagnosis was correct compared to the others, while other providers wanted me to get straight to the point. I would always end up carrying what the last preceptor wanted out of me to my next preceptor, and it really did not work out for me at all. Of course, after presenting the first or second patient, I knew what the preceptor wanted, but it was just annoying that I had to make that transition every day. But I guess that is the reality of working. For the rest of my career, I will be presenting to different attendings and I will have to understand how they like their presentations to be made, what to focus on, what to leave out, and so on. For the most part, this was the least of my worries and I enjoyed working with all of the staff that I was assigned to.

Overall, I am very grateful for my experience in Queens Hospital. There are obviously somethings that I would have changed about myself when entering the rotation, but what is done, is done and I am happy that I got to experience what I did. With all this being said, I know for sure that I would not be happy in the emergency room. It does not bother me that it is fast pace, I actually loved that part. It bothers me that there seems to be minute interaction between the provider and the patient, and I understand that is that the providers fault, but personally, I want to satisfaction of giving my patients the satisfaction of quality time. My perception might be skewed because of my love of my previous rotation of psychiatry, where I would sit down with patients and unpuzzle them, but I absolutely loved it. I think the best medium for me at this point would be to work in both internal medicine, where there is time on the floor to sit down and chat with certain patients if required and you also keep up with medicine, and then psychiatry as well, because I am a hard core believer that mental health is just as important as, if not more important than physical health.

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