APPE Reflection: Internal Medicine

Wow… I cannot believe I only have 1 rotation left! This month went by so quickly. This month was a whirlwind in terms of everything happening all at once. I had several post-grad job interviews, and I had a lot going on personally otherwise. However, I feel like I was really able to make a difference for my patients during my Internal Medicine rotation.

I made countless recommendations to providers (primarily changing up insulin regimens and adjusting antibiotics), but one in particular stands out. We had a patient that was in for possible infective colitis (inflammation of the colon caused by bacteria) who subsequently got a new diagnosis of Non-Alcoholic Steatohepatitis (NASH), which is a type of liver disease. He had ascites (fluid buildup in his abdomen due to the liver disease), which increased his risk of a bacterial infection of the inner abdomen called spontaneous bacterial peritonitis, or SBP.

Why this is important is that I have had experience with patients with liver disease and ascites who do develop SBP and actually did a case presentation on a similar patient a few months back. I noticed that his white blood cell count (WBCs) had been trending up and he was on appropriate treatment for colitis. I mentioned to the provider that the patient could now have SBP and that we should consider getting a paracentesis (sample of the ascitic fluid) and possibly switching antibiotics. Once we got the results of the paracentesis, it was noted that the patient did have SBP, so the recommendation to switch antibiotics was accepted. This provider was extremely thankful for my input and this recommendation, which I made during the first week of my rotation, helped me to build a great professional relationship with that provider.

I took part in another mass COVID vaccination event at the beginning of the month.

A lot of this rotation was focused on learning antibiotics, which I really needed. I have always had a hard time keeping antibiotics straight, but now I feel like I understand them a lot better. I also gave a case presentation on bacterial meningitis at the end of the rotation.

Overall, this rotation was a great experience for me, and I am so glad that I got the opportunity to experience it.

Stay Golden,


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