On my family medicine rotation at CitiMed JFK I worked primarily with individuals who were injured at work (i.e. worker’s compensation) and those who needed employment physical examinations for work. As a result, my exam often focused on various aspects of the musculoskeletal system such as the neck, back, shoulder, hip, and foot regions. During my other rotations, I had not focused on this area of the physical examination as much, thus at first this presented as more of a challenge for me. I had to review my old Physical Diagnosis lecture/lab notes and familiarize myself with the numerous “special tests” that we learned about in didactic but I had not performed in quite some time. Soon enough I became comfortable with performing tests such as the anterior/posterior drawer, McMurray, Lachman, Hawkins-Kennedy, and Obrien’s amongst others. I will be sure to continue to practice these maneuvers for future rotations and ultimately for certified practice as well. 

What was a memorable patient or experience that I’ll carry with me:

On this rotation I was able to conduct a full history and physical on each patient before presenting him/her to my preceptor. In doing so, I was able to establish rapport and a connection with many of them. As mentioned earlier, most patients presented with work-related injuries, however their stories were often much deeper than that. I had a patient who was in a no-fault car accident, resulting in the need for left shoulder repair surgery among other problems (i.e. consistent neck, back, and leg pain). She was about a week s/p surgery when I met her and therefore she was in a left shoulder sling with limited ROM. She informed me that a few days prior her PCP sent her for a routine mammogram which showed malignant cancer cells in her left breast. After consulting an oncologist, it was determined that the cells were mutating fast and that she needed surgical resection ASAP to prevent further spread. Unfortunately, the malignancy was located in her left breast, which was unaccessible due to her recent shoulder surgery- she would need several weeks of physical therapy before a surgeon can access her left side. I sympathized with her about her unfortunate situation and we discussed for quite some time about the predicament. I commended her for her positive outlook and attitude and told her that together as a team we will make a plan that works best for her situation. 

How could the knowledge I’ve gained here be applicable in other rotations/disciplines:

On this rotation I was exposed to occupational health, a field of medicine that I would otherwise have not learned that much about. Occupational health covers so many different aspects of healthcare, and with every patient seen there are numerous conditions to consider. Not only are you treating their presenting musculoskeletal complaint, but often times there are associated neurological or psychological aspects that come along with the diagnosis (i.e. headaches, loss of consciousness, depression, anxiety, PTSD). Additionally, many patients were diabetic, hypertensive, or hyperlipidemic which played a role in choosing an appropriate treatment plan. I even had a handful of pregnant patients which affected course of action by preventing any x-rays from being obtained if they presented with suspected fractures. 

What did you learn about yourself during this rotation:

Prior to starting this rotation, I was unsure how interested I was in occupational health and how much I would learn from such a rotation. I was under the false impression that I would solely be engaging in the musculoskeletal system. In reality, I was able to perform full comprehensive physical exams on patients needing clearance for work, and was even able to perform certain procedures (i.e. removing glass from a patient’s finger, wrapping a patient’s ankle in an ACE/ hard sole shoe, flushing out patients’ eyes who had metal/foreign bodies embedded). It was a great opportunity to continue to become more comfortable presenting patients, as with each patient I saw on my own I had to then present to my preceptor. This was certainly an education experience and I look forward to taking the skills I obtained on this rotation and applying them to my final ones, and ultimately to my future practice too.