LP: Family Medicine

As part of the Physician Assistant program at McMaster University, students are expected to complete three Longitudinal Placements (LP). Students are responsible for setting these placements on their own. LPs are clinical observerships organized by the student in the domain of his/her choice to gain relevant clinical knowledge in that are of medicine.

  • Area of Longitudinal Placement: Family Medicine

1. What LP did you do?

I did my LP in Family Medicine in Toronto

2. How did you go about contacting and arranging the LP?

Initially, I planned on completing my family medicine LP with the clinic I volunteered at during the summer. Unfortunately, they already have a medical resident and medical student doing a placement during the times I requested.

As part of the PA program, we are assigned student advisors who are our mentors for the duration of the program (and hopefully beyond!). I told my student advisor, Sahand, about what happened with my initial attempt at securing an LP and he told me that it happens and not to worry. He contacted a friend who works in a family clinic in Toronto to see if they can take on a PA student for a few days. I am so grateful that they  offered me two full days and two half days at the clinic. Thank you, Sahand!

3. What were the main things you learned from the LP?

1) Following the physician and the PA, I was able to see what sort of concerns patients came in with. Some for rashes, abdominal pain, prescription renewals, etc. I also got to see a lot of procedures done: cortisone shots, pelvic exams, abscess removal, etc. There was one day I did not come in and I am so bitter now because I missed out on seeing how an IUD was inserted 😦

2) I was able to see how a PA fits into a family clinic. The PA had patients booked under his name, meaning he sees the physician’s patients on his own. Under his medical directives, he’s able to prescribe medication with the exception of controlled substances and narcotics (this applies to all PAs and NPs). When we study medicine, we often assume that patients coming in have a physical problem. However, sometimes patients come in with a psychological problem eg. ADHD, anxiety, depression. These patients and others who have complex cases may need more time with the Physician than the allotted 15-minute appointment. So, while the physician spends more time with these patients, the PA sees the next patient on the physician’s list in addition to the patients booked under him. From what I’ve seen, their patients are happy to see either the physician or the PA

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3) I learned new skills. The physician spent time going over how he takes a history and makes sure I understand why he asked certain questions. The PA gave me examples of how to approach smoking cessation. Another physician went over with me how to do birth control consultations. Another physician showed me wonderful resources to use. I also received some pointers on how to approach learning antibiotics. Lastly, I was taught how to administer intramuscular (IM) injections! I was given a needle and tangerine to practice the night before. I administered two IM injections: one was a flu shot, another was a vitamin B12 shot.

4. What did you wish you knew beforehand to help you in your LP?

I wish I reviewed my dermatology notes. We often forget that patients come in with complaints about rashes!

5. How has this experience helped you clinically, in class and/or in career decision-making?

My tutor suggested that I get more clinical exposure from doing Longitudinal Placements. It seems that my learning style is “The more I see, the more I know”. Which is the reason why I decided to do an LP during my two-week break from school. This exposure will help me do well in the program and in the profession.

My goals going into this LP was to practice/observe how a history is taken and observe procedures that get done in a family clinic. My preceptors taught me more than that. Family medicine is definitely on the top of my list of where I want to work when I graduate.

6. Share your most memorable experience from the LP!

SHINGLES! On my first day, I saw three patients with shingles. I actually got pretty excited when the physician had me guess what the rash was on the third patient.

Shingles (Herpes Zoster)

If you had chicken pox when you were younger, the virus still lives within you…in your nerves! Under certain triggers, like stress, it resurfaces as a painful rash.

If detected within 48 hours, Valtrex (an antiviral) can be given to lessen the symptoms. If not, the virus is self-limiting and will resolve on its own. Patient can take some over the counter pain meds to relieve the pain (Tylenol, Aleve, etc).

The one complication physicians are concerned with is postherpeutic neuralgia in older populations. This is where the nerve pain from the rash caused by varicella zoster virus stays even when the rash has resolved.

Overall Experience

I had an amazing experience! All the doctors and PAs there were very supportive and happy to educate me. I learned a lot from my preceptors. They both gave me advice on how to improve myself and how to become a good Health Care Professional. One lesson the physician taught me was this, “Sometimes patients come in with what we think is a trivial problem but to the patient it was a big enough problem that they want to come to the clinic”. As a health care professional, I want to do my best to address my patient’s concerns…whether they are trivial or not!

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