Site Evaluation Presentation Summary

For my final site evaluation, I presented on a case of an 18 year old female who came into urgent care c/o chest ache and nausea after taking Clindamycin for two days for an inguinal cyst. The patient admitted to having headache, nausea, chills, night sweats, body aches, generalized abdominal pain, and decreased appetite afterwards. After taking her vitals, we discovered that she had a 102.1 fever but the patient was not aware that she had a fever. Because she had a fever while taking Clindamycin, we were concerned about her having septicemia.

As for the ROS and PE examinations, everything was unremarkable except for some bilateral submandibular and anterior cervical chain lymphadenopathy and generalized abdominal pain throughout all four quadrants. I made sure to check her ears and throat for signs of infection (like strep throat) and to see whether she was dehydrated by checking her mucous membranes, which were moist, and her skin, which did not tent. Due to our initial concern of septicemia, we decided to run a CBC with differential and blood cultures.

During the mid-site evaluation, Prof. Mohamed discussed with Noor and I multiple cases, even ones that we were not presenting as part of our H&Ps (for example, conjunctivitis, frozen shoulder, antibiotic use, anemia). Through our discussion, we found out that urgent cares may not practice the safest or most appropriate medicine because customer satisfaction is one part of the business. When I presented a case about a tick bite with a tick that eventually tested positive for carry Lyme, I was told that the CDC did not recommend any doxycycline as prophylaxis. However, upon further research, we discovered that a single dose of doxycycline 200mg should have been given to the patient when he first came into the urgent care. Prof. Mohamed taught me that if there is time, I should briefly look up treatment options to find out what is most appropriate for the patient. Being aware of updated practices and what the first line treatments are important so that we do what is best for our patients. From the mid-site evaluation forward, I was more careful in double-checking treatment regimens myself instead of solely relying on the experience of the providers that I was with.

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