Emily B.

January 7th – January 14th (4 hours) –  I recently was able to do my first throat swab to test for strep. A patient came in complaining of throat pain along with common cold symptoms, and my mentor allowed me to swab his throat. As boring as it may seem, it was a cool experience for me because I had never done that before. I have been doing rapid strep tests in the lab, but never performing that throat swab. The test came back negative, but it was still a cool task I got to do. This makes me more confident that the next time a patient needs a throat swab, I will be able to perform it and help out my mentor even more.

A soft skill I’ve developed is the ability to have better interactions and conversations with patients. As a high schooler with minimal medical training, it is often times intimidating to be surrounded by people who have had more years of medical training than I’ve been alive. At first, I was nervous to say anything at all to patients in fear of them asking me questions that I couldn’t answer or having higher expectations of me than they should. As I’ve spent more time with patients, I feel more comfortable communicating with them, even if I don’t have the medical training that other staff do. My mentor was able to reassure me that even with the minimal medical training I have, I actually know more than most patients do. Seeing her interact with patients has been helpful as well, because the dialogue that she uses has been helpful to copy. I practice my patient interaction skills every day that I’m at my internship, since most of my job is to ask them questions about their medical history. I will continue improving this skill as I have more patient interactions and boost my confidence.

This skill will benefit me in college because it will allow me to become more comfortable in social situations where I may be lacking knowledge or experience. It will allow me to approach these situations with an open mind, rather than timidness. Especially as a freshman in college, most people I will interact with during my time there will know more than I do. Instead of being scared of them, I can learn from them and what they know that I don’t. In a more direct way, this will apply to my career as a nurse because as a nursing student and a new nurse I won’t know as much as my coworkers. I will already have experience talking with patients, so I will be more comfortable than some of my fellow nursing students. As a nurse practitioner also, when I do have more experience, this will allow me to reassure others in my situation just like my mentor has done for me.

Last week at my internship, I observed a PT/INR test. My mentor explained to me that it tested the blood’s ability to coagulate. It was a simple finger-prick test much like glucose or hemoglobin, just a different machine. PT/INR stands for Prothrombin time/international normalized ratio, which tests for both bleeding and clotting disorders, as well as monitoring how well blood thinning medications (which this patient was on) are working to prevent blood clots.

January 15th – January 28th (16.25 hours) –  Last week at my internship, a patient came in for an ER follow-up. He had gone to the ER because he was having chest pain. According to him, the hospital did not do any blood work and they did not do an EKG to analyze his heart rhythm. So Nancy, (the FNP at UCHC), asked Rebecca and I to do a EKG on him to make sure everything was okay. His EKG came back abnormal, which I have never seen before. His heart was in atrial flutter, which can cause a heart attack. The EKG also showed a second-degree atrioventricular block, which can cause the heart to skip beats. When we showed Nancy the EKG, she told Rebecca to call the paramedics because he needed to go to the hospital and she was not going to let him drive. He didn’t seem to be in that much physical distress, but he had told me when I was taking his medical history that he thought he had a chest cold because it felt like somebody was sitting on his chest. It was a little bit scary to have to call the ambulance. Rebecca said she has only had to do that one time before, so it was a unique experience even for her. I learned through this experience that medical emergencies aren’t always how you see them in movies, with paramedics flying in the door and yelling and it being total chaos. It was a very calm event despite the danger the patient could have been in, which made it easier for the patient to stay calm.

This week, I helped out Jackie by entering immunization records into the computer when she had to leave early. The system I input the data into is called ASIIS, which stands for Arizona State Immunization Information System. This is the state-wide database that all shot records for patients can be put into, so that all physicians state-wide can access patients’ shot records even without a physical copy of them.

January 29th – February 11th (13.5 hours) – Last week at my internship, I was working on the pediatric side all week. Dr. Ramsower is really good about showing me and Bailey an interesting case if it arises and walking us through it. She asked me if I wanted to see a cool rash, so I said yes. There was a 6-year-old boy who had a low-grade fever for a few days and then developed a rash that wasn’t going away. She lifted up his shirt so that I could see the rash and immediately I knew what it was. I told her “Isn’t that pityriasis rosea?” She was super impressed and said that was exactly what it was. I looked really smart, but the reason I knew that was because I had pityriasis rosea about 6 months ago. She told me later that week that she was still really impressed that I had known what the rash was and the father of the patient was really impressed as well. It made me feel really good that I was able to actually apply my medical knowledge in that situation. Usually, I am just documenting information and documenting test results and am left to speculate what I think could be going on in my own head. I accurately diagnosed something for the first time which really boosted my confidence for the rest of the week.
 
For my first SMART goal, I chose to learn the healthy an unhealthy range for urinalyses for three of the test categories. I chose this goal because urinalyses are a common lab procedure that I perform at my internship. I know how to read the test strips, but I have never understood the implications of the results. Instead of researching only 3 categories, I chose to look into all of them, because most of the time, a simple positive or negative in a category indicates important information. These categories were: specific gravity, pH, bilirubin, urobilinogen, protein, glucose, ketones, blood, leukocyte esterase, and nitrite. In order to learn these levels, I went online and looked up the healthy levels of these categories. Through my research, I was able to not only learn the healthy/unhealthy ranges, but I learned what kind of bodily issues could be determined from abnormal urinalysis test results. Though online research and studying were how I achieved my goal, I was immediately able to apply my newfound knowledge in the clinic. This allowed me to further my learning experience by interpreting the results first hand and drawing conclusions based on them. For instance, after I learned that excess glucose in the urine may be a sign of uncontrolled diabetes, we had a new patient come in for a check-up who stated that he had previously been diagnosed with diabetes, but had it “under control”. After testing his urine, his glucose levels were 2,000+, which I knew meant that his diabetes was not, in fact, under control. I did not encounter any hurdles while completing my goal, as it was mostly research based. Something that stood out to me, however, was that some urine test strips test for ascorbic acid, or vitamin C. This is because if a person is taking vitamin C or multivitamins, the vitamin C excreted in the urine can interfere with the test results, potentially resulting in false positives and false negatives for several of the categories. I wondered why ascorbic acid was so important and why doctors looked for it, and it’s not because the absence of vitamin C is concerning, it simply interferes with test results. My research went well, and I keep the notes I took in my white binder that I take to my site so that I can reference them frequently when I need to refresh my memory. I am still working on memorizing the importance and the ranges of each of the categories, but this will come with more studying and more experience with reading test results. As a future health-care provider, urinalysis levels will be an important test I will utilize in order to take a look into the functioning of a patient’s body. It is important for me to not only be able to perform these tests, but also to know what the results mean. Though I am positive that I will learn this during nursing school or while I am pursuing my nurse practitioner degree, I will already have the experience with urinalyses and I will know what each of the categories is testing for, what is healthy, and what abnormal findings could mean. I will be more confident in my abilities, while the rest of my classmates will most likely be getting this basic information for the first time, giving me a step up in my skills.

Going along with my two-week recap, Pityriasis rosea was the rash I saw in the 6-year-old boy. It is a common rash that begins with a “herald patch” and spreads in a Christmas tree pattern. About 50% of the time, people experience itching with the rash, but I did not and neither did the 6-year-old. The cause of pityriasis rosea is unknown and there is no known cure. It is not contagious and resolves itself completely within 1-2 months.

February 12th – February 25th (13.5 hours) – This semester, I have been getting more and more confident in my internship. I feel like I have been able to overcome a lot of personal insecurity at my site and others have started to notice that as well. Last week, I was validated in this by my mentor, Rebecca. She told me that she and Sylvia, the receptionist at the clinic, were talking about how much I’ve improved and how fast I am now at rooming patients. They agreed that a job opportunity they heard about would be a great position for me. She said the job title is a “technician” and that I wouldn’t need any certification to be considered for the job. The job duties would basically be everything I do now, along with some administrative duties, and I would be getting paid for it. Though I currently have another temporary 10-week job, I’m excited that I could possibly turn the skills and knowledge I’ve gained during this internship into a paying job. She said she didn’t know what locations were looking to fill this position or if they were full-time or part-time, but that she could get back to me with more information. It makes me feel really good that my co-workers can see my confidence improving as well as my skill level so much so that they’d be willing to recommend me to work for their company. This motivates me to continue building on my skills I’ve learned so far, knowing that I’ve come a long way since I first started.

Nitrites are chemicals that can be found in urine. The presence of nitrites could indicate a urinary tract infection. Last week, I did a urinalysis and the patient tested positive for nitrites. I have previously researched nitrites but referenced back to my notes to double check what the presence of nitrites meant.

February 26th – March 11th (12.5 hours) –  Most people in my life and at school know that I intern at a health clinic. On more than one occasion, I have had people come up to me and show me their lab results to ask me if their levels were normal. The most recent incident happened when a fellow classmate came into the clinic. He was tested for the flu and got some routine labs done as well. A couple of days later in English class, he pulled up his labs on the online portal the clinic has and asked, “Are these normal??” I’m not an expert on all lab levels and their normal ranges but at the top of his page it said “All levels within normal ranges”, so I told him they were normal but to call Rebecca if he had questions about them. Obviously, I’m not yet a medical professional and I’m not going to advise anybody medically if I don’t know what I’m talking about. But, it makes me feel good that people know I’m somewhat knowledgable in medicine. I love helping people and I can’t wait until I can actually start making people feel better physically because of my knowledge of medicine.

For my second SMART goal, I chose to practice manual blood pressure reading at home for 10-15 minutes a week in order to increase confidence taking blood pressure at UCHC. I chose this goal because the blood pressure machine I use at the clinic to take vitals is automatic. Sometimes, because technology can be finicky, blood pressure needs to be repeated or taken manually. I usually have to ask Rebecca or Jackie to take a patient’s blood pressure manually since I wasn’t yet confident enough to take it manually myself. I learned how to take blood pressure in sports medicine a year or two ago, but I haven’t practiced since then. Even when I learned it, I never felt very confident that I was getting the right numbers. I refreshed my memory with a few Youtube tutorial videos that showed me how to take blood pressure manually. To practice, I took my mom, my dad, and my sister’s blood pressure every other night for three weeks. I tried to take mine as well, but it was much more difficult to practice on myself compared to other people. I would then take the reading I got manually and compare that to the reading the automatic blood pressure machine we have at home got. One hurdle I encountered at first was that the readings I got were consistently high compared to the blood pressure machine. I was getting really frustrated but then I realized that the needle was starting at 25, not at 0. Which explained why my readings were around 20 off. I then had to Youtube how to recalibrate a sphygmomanometer (the fancy word for blood pressure cuff). Something else that was difficult was that technology is not always reliable, so I had a hard time trusting the readings from the blood pressure machine. Even at the clinic, manual and automatic blood pressure can differ greatly. So I wish I had somebody who also knew how to take blood pressure so they could confirm the readings I was getting rather than a machine. After that, it was pretty much smooth sailing. Since I already learned how to take blood pressure manually at one point, I got the hang of it pretty quick. It got pretty repetitive after a while because it wasn’t too difficult. I am now able to get readings much faster than when I first started practicing. Being confident and able to take blood pressure will help me at the clinic because if a patient’s blood pressure needs to be repeated or taken manually for any reason, I will be able to do that myself instead of taking Rebecca or Jackie away from what they are working on at the moment. Additionally, this will be a skill I definitely need to know in the medical field. Abnormal blood pressure levels can make a patient feel very ill and can alert physicians to an underlying health problem. Being able to check blood pressure is a skill everybody from Medical Assistants to surgeons need to know how to do. Now, I have a head start on this skill which will help me in college and in the immediate future at the clinic.

A lot of patients who come into the clinic have bloodwork done as part of their well checks. Nancy often tells Rebecca that she wants a “CBC” done on a patient. I knew that this was blood work, but CBC stands for Complete Blood Count. This means that several components and features of the blood are measured, including red blood cells, white blood cells, hemoglobin, hematocrit, and platelets.

March 12th – March 25th (0 hours) –  I was out of the country over break, so I did not go into the clinic. However, I had to reverse my usual role of being a worker in a clinic and be a patient instead. My parents were out of town and I had to go to Urgent Care by myself because I was having muscle spasms in my back. I have never gone to the doctor by myself before, as I only turned 18 two months ago. I think my experience working in a health clinic made me more comfortable going by myself. I know the process of how patients are processed and what to expect because I’m usually the one helping with that. It’s scary when you don’t feel good and you’re all by yourself, but I’m glad I had the experience of my internship to prepare me for the day I would inevitably have to be an adult and take care of myself without my mom or dad there to help me. If I hadn’t been working in a clinic, I wouldn’t have been confident enough to go by myself and I would have been suffering longer than I should have been.

Norflex is a muscle relaxer that can be injected to stop muscle spasms. I didn’t have to get this done, but when I was researching possible treatments for muscle spasms, this was one option. I have seen this done at the clinic before, but I didn’t know what it was called.

March 26th – April 8th (7 hours) – In a previous reflection log, I talked about an interaction with a patient I had whose cancer had relapsed. She cried to me about it and all I could do was get her some water and I felt pretty sad. I recently learned that she passed away. After Nancy referred her to the oncologist, she got a PET scan which showed that her cancer had metastasized into her brain. This is the first time I’ve had a patient I interacted with pass away. Rebecca will tell me every so often about a patient who passed away, but I had never seen them in the clinic. This made me pretty sad since I had a personal interaction with her that I will vividly remember probably for the rest of my life. But I know that I couldn’t do anything else other than listen to her and make her comfortable, which I did. It’s just sad to know that some people you really can’t help. But also, death is a part of the healthcare field that I will encounter in my career and it’s good to start learning how to process these emotions.

This internship has taught me that I’m better at talking to people than I thought I was. I’ve always considered myself shy and socially awkward at times, but I’ve realized that I actually really like meeting new people and interacting with them. I know this also comes with being comfortable in an environment, but I think I need to push myself to be more outgoing even when I’m not comfortable yet. I’ve also learned that I still need to work on asking questions. Sometimes I still struggle and try to figure something out for myself instead of asking for help. I mostly do this out of fear of being judged or looking dumb, but really it’s worse to waste time than to ask for help. Even though I know this, I still get anxious about asking for help. This is something I can definitely work on.

1. Your calendar is your new best friend!
Even though it’s required to have a calendar for the internship program, put everything on there! It’s much easier to schedule your internship hours if you have everything else in your life visible as well. Being able to visualize and plan out my week has made my life a whole lot less hectic.

2. Ask lots of questions!
Wherever you are placed, it’s really important to get to know your environment and the lingo around you. Don’t be scared of sounding stupid, because your mentor or coworkers will more likely than not be totally willing to explain something to you. The more you know about your field and your site, the more useful of an asset you are to your mentor.

3. Don’t be afraid of making mistakes!
Mistakes are part of learning, as long as they’re the right kind of mistakes. Nobody is perfect, especially considering that you are all probably brand new to the environment you will be interning in. This goes along with asking questions, but you’re not going to be judged because you didn’t know something that other professionals who have worked their whole lives in the field know. View mistakes as learning opportunities, not failures.

An ampoule is a sealed glass containing liquid. I had never seen one of these before, but injectable antibiotics at the clinic are stores in these little glass containers. In order to open them, the glass has to be broken and then the antibiotic can be sucked up with a syringe. My mentor had never used one of these and was scared to open it, so we were laughing about it together. She eventually had the other MA open it for her because she was scared that she would cut herself on the glass.

 April 9th – April 22nd (0 hours) –  Though I have completed all my hours, the next big step I took towards finishing my senior year of high school was my practice Senior Exit Project presentation. I presented my project two weeks ago and it went very well! I of course talked about the internship program and the unique experience I had as a part of my Senior Exit Project. My peers were interested by how hands on I got to be and I got a lot of questions about my experience there. At first, I was really nervous to present but once I got in front of my peers to talk about something I knew I had a lot of knowledge and experience about, I felt relaxed. I was really proud of my visual aide too, because I got to take somebody’s blood pressure. Taking manual blood pressure was one of my SMART goals so I’m glad I got to demonstrate that. I also really enjoyed learning about my peers experiences, both in the internship program and not. I realized I didn’t really know where other students in the internship program were placed, so I really liked getting to know about their experience. I got a 19/20 on my presentation, so I’m feeling confident going into my real presentation next week.

For one of my peer’s visual aids, she demonstrated how to draw blood. She explained that through her JTED program she is going to be an MA, or Medical Assistant and also a CPT. CPT stands for Certified Phlebotomy Technician. This means she is certified to draw blood.

July 20th – August 13th (0 hours) – I have yet to start an internship, but a meaningful experience I have had so far has been the “Getting Hired” class we all took over the summer. A huge part of the class was focused on social media in relation to getting hired at company and it really got me thinking about my social media presence. I have always kept appropriateness in mind with my social media accounts, but it got me really thinking now before I post, “Is this something I would want my future boss to see?” Before, I only used to think, “Would my mom be upset if she saw this on my profile?”, but I’ve realized that even though my mom may not be upset about a post, some of the posts on my Facebook from when I was in middle school I would never want anybody to see- they were so embarrassing- but much less my future employer. I’m not the person I was when I was in 6th grade, so I don’t want my employer getting that impression. It also made me think about and adjust my privacy settings on my social media accounts. Though I think it is good for employers to get a general idea of their potential future employees, I don’t want strangers that stumble across my profile to have a general idea of me, because they don’t need that information. With the world being so technology dependent, it’s good to be aware of what I want strangers and my employers to see about me online.

From my mentor, I hope to learn how to approach a child who is intimidated or scared by going to the doctor. Since I want to be a pediatrician, I am going to need to know how to make doctor’s office visits the least traumatic for the child and the parent(s), and hopefully not even just less traumatic, but as enjoyable as possible. I know I always looked forward to seeing my pediatrician because she was so nice and calming and I knew she would make me feel better. From Mrs. Wahl/Mrs. Polivchak, I hope to continue how to build my professional communication skills. I think that I have already learned a lot, in terms of replying to emails within 48 hours and leaving professional voicemail messages, but I want to continue to learn and practice how to communicate efficiently with other professionals outside of the internship program. With communication, I also want to learn how to express concerns I have immediately, instead of keeping it to myself and getting stressed out about it. Though that’s not something that can necessarily be taught to me, practicing with Mrs. Wahl and Mrs. Polivchak will prepare me for the real world.

As a professional, through the interview process at the end of last year, I learned how to interview for a job in a way that will give a potential employer the best first impression of me as possible. I learned and practiced responses to the most common interview questions that are asked, which has made me more confident in my abilities going into interviews for other jobs. I’ve learned that the first impression that you make can really make or break your time at the company and how your superiors think of you- so far that has all been a positive experience for me. As a student, I have learned the importance of keeping a digital calendar. This can apply to the professional world as well, but I know that since I plan on attending college next year, balancing work and school will be tough, and the system I have right now really works for me. On my Google Calendar, I have color coded everything into groups and have gotten into the habit of putting something on my calendar as soon as I learn about it, which has helped me stay organized and on top of assignments and events. I feel much less overwhelmed with school and work and my internship when I can visually see my schedule whenever I need to reference it.

August 14th – August 27th (4.25 hours) – This past week I have started shadowing my pediatrician, Dr. Lloyd, while I wait for my internship at UCHC to start. While I was at her practice, Catalina Pediatrics, I was greeted incredibly warmly by all of the staff, parents, and patients that even in the short amount of time I have been there, I have confirmed my want to pursue pediatrics as a career. Dr. Lloyd asked every patient and parent if it was okay if a student could observe their appointment and all of them were so excited that I was learning from Dr. Lloyd. The parents all asked me about what I wanted to do after high school and encouraged me to keep pursuing pediatrics. I love being around children and the kids that were in the office were so sweet. Dr. Lloyd was doing a well check on a three year old boy and while she was palpating his abdomen, she asked him, “What’s your favorite animal?” And he responded “Um… cars.” Kids always say the funniest things and it makes me so excited to one day be able to interact with them and listen to their cute sayings and stories as my job. I’m more excited and motivated than ever to keep pursuing a career in pediatrics because my experience has been so rewarding so far. I’m look forward to continuing getting the hands on experience I crave in the field I am so passionate about.

August 28th – September 10th (2.92 hours) – One meaningful experience I recently had was this past week when Dr. Lloyd had a mom of one of her patients call her incredibly frazzled because she claimed that her 3 year old child has measles. Dr. Lloyd was confused because she hadn’t seen the patient, but the mom said that she had gone to urgent care and they had diagnosed her child there. Dr. Lloyd asked if they had done bloodwork done- since that is the industry standard for diagnosing measles- and she said that they hadn’t. Dr. Lloyd referred her to an Infectious Disease specialists where they could do bloodwork and diagnose the patient for certain. Then, she started getting calls from panicked family members saying they had been exposed to the child with measles and they were asking Dr. Lloyd- a pediatrician- what they should do instead of calling their own doctors. What I learned from this is the importance of a second opinion and the importance of physicians to be 100% certain in their diagnosis before inciting panic. The physician at Urgent Care should have never told the family that their child had measles without doing the proper procedure for a diagnosis of such a serious illness. Because of their misdiagnosis, Dr. Lloyd had to deal with the fallout from not only her patient and her patient’s mom’s concern- but other family members panicking as well. As for the patient’s mother- going to a less experienced doctor when dealing with such a serious illness was not the best decision. She should have gotten a second opinion from a more experienced or specialized doctor before telling her whole family they could be at risk for measles.

Since my site is a pediatrician’s office, appropriate behavior is very important when dealing with children. Physicians and nurses are all very polite, but still friendly with each other. Obviously, no foul/obscene language is used, as it shouldn’t be in most professional environments. Conduct tends to differ in the office depending on who is around. When healthcare professionals are with a patient, their personalities are bubbly and kind while not being too intimidating and they speak in simpler terms so that the patient understands what they are doing and why. When they are talking amongst each other, their vocabulary is much different and they speak using proper medical terminology rather than making it simpler for others to understand, since they all have shared knowledge. Overall, the office is a rather quiet and calm place.

This is a very natural fit for my personality. I tend not to be super loud and outgoing and places that are loud overwhelm me. Being in a calm, quiet environment like Dr. Lloyd’s office has been rather nice for me. However, I am a little bit shy and that it something I could work on. It is hard for me to express that currently, since I am just shadowing and don’t have a lot to say, but working on talking to other nurses and the one or two other pediatricians that are there at the same time is something I could work on. Since I have been babysitting for so long, I think I actually have an easier time interacting with children. Interacting with adults is what I have more difficulty with, just because they are more experienced than me and I am intimidated by that. With more experience I think I will become more confident and social in a professional environment.

A huge part of pediatrics, especially when doing a visit with a well child, is keeping up to date on vaccinations. Recently, while observing an annual well check for a 4 year old, Dr, Lloyd said that the patient was due for their DTaP vaccine and she had to check with the nurse to make sure they still had the particular vaccine in stock. DTaP stands for Diphtheria, Tetanus, Acellular Pertussis, Polio Vaccine. This is a combo vaccine, meaning there is more than one kind of vaccination in a vile so that the child does not have to get 4 separate shots, reducing stress on the parents and the patient.

September 11th – September 24th (4.5 hours) – Recently, I learned about the importance of second opinions when diagnosing a condition. A three year old girl came in, who’s mom said that her “ringworm” was getting worse. She had been previously diagnosed with ringworm by another physician at the same practice. However, when Dr. Lloyd examined her red spots further, she concluded that she did not in fact have ringworm, just eczema. So, the antifungal cream that she had been prescribed was not helping anything, because it was the wrong condition being treated. Instead, all she needed was a good quality lotion to treat the dry patches. Dr. Lloyd told me after the appointment that the other doctor tends to think almost every skin condition is fungal, when most of the time it isn’t. Even doctors who have gone through years of schooling can still have biases, which is why getting a second opinion is so important.

In order to start my internship at UCHC, I had to get a TB test this past week. A TB Test is given by injecting a small amount of the TB test liquid underneath the skin very superficially and then waiting 24-72 hours to see if a reaction occurred, indicating a positive TB Test. My TB test came back negative, as I did not have an abnormal reaction in the area where the liquid was injected after 72 hours.

September 25th – October 8th (4.2 hours) – One meaningful experience I’ve had over the past two weeks taught me the importance of always giving patients the benefit of the doubt. A sixteen year old girl came into the office complaining of throat pain and swelling on one side of her throat. Since there has been an increase in allergies lately, I immediately thought to myself that she might be overreacting, since she felt completely fine otherwise, with no fever or other symptoms. Dr. Lloyd did a strep culture just in case and to both of our surprises, she tested positive for strep. Had I been the patient, I would have ignored my symptoms and chalked it up to allergies, and had I been Dr. Lloyd I would have recommended taking an allergy pill. It’s important to take every patient’s symptoms seriously, no matter how small, and to do the appropriate tests even if the expected result is negative.

Since my pediatricians office is very small, the only form of communication needed is talking face to face. I’m constantly following Dr. Lloyd since a huge part of interning in the medical field is observing. Since I’m never apart from her, whenever I have a question I ask her when we are alone in between patients or when she is charting. I don’t ask questions or participate in the appointments, so I usually have a lot going through my mind and will ask her right after since the appointment is fresh in my mind. This is an appropriate time and method because it isn’t in front of patients or parents, so I don’t take away time from them and I get an immediate response to my question. Even between physicians and/or nurses at the practice, they all speak face to face when they need to communicate. It is more efficient to use face to face communication when possible, because it is much faster than an electronically delayed response.

I am very comfortable in deciding the appropriate communication method, which is partly because of the fact that I almost always use face to face communication. Personally, I think that face to face communication is less daunting than electronic communication because my tone is much easier to convey, while with electronic communication I tend to overthink any messages I send and get anxious about how I might come off unintentionally. I usually communicate as soon as I have a thought, since I am always with Dr. Lloyd. If a question comes up during an appointment, I might write it down since I don’t want to interrupt, and then ask the question later. Since appointments are relatively short, I can usually remember my question and then ask her after we leave the room. If I ever need to contact Dr. Lloyd electronically, I use text and then I spend more time sending a message in order to convey the proper, professional tone.

I learned the term “venous hum” when I got to listen to a three year old’s heart with a stethoscope. A venous hum is the sound of blood flow returning to the veins above the heart. It is technically a “heart murmur” but is completely harmless. Dr. Lloyd said that since children have little body fat and their hearts are so close to their chest wall, it is common to hear a venous hum.

October 9th – October 22nd (0.5 hours) – Last week I finally got to visit my actual internship site and meet with one of my mentors. I have been looking forward to this for a long time since the legal paperwork took a long time to process. Mrs. Pratt asked me about my future career goals to determine which physician I should shadow while I am there. I will have the opportunity to shadow both a family nurse practitioner and a pediatric nurse practitioner, which will help me decide what master’s degree I want to pursue after I get my bachelor’s degree. I learned about the basics of the clinic; such as their hours, which physicians work which days, the names of the other employees, and “dress down days” on Fridays. I feel like I will make a good addition to their team and I am excited to start interning at UCHC on Friday.

HIPAA stands for Health Insurance Portability and Accountability Act. This law requires the protection and confidential handling of protected health information by healthcare professionals. In order to start my internship, I am required to complete an online course about HIPAA to ensure I uphold a patient’s right to privacy.

October 23rd – November 5th (8.1 hours) – Last week, a 12-month-old came into the clinic for his one-year checkup. The 12-month checkup is notorious in healthcare for being one of the most dreaded because at 12 months old a child needs 6 vaccinations. It was the job of Jackie, the M.A. that a shadow, to give the one-year-old his shots. The poor baby cried until he fell asleep. This showed me the not-so-fun, but still very important side of healthcare. Afterward, Jackie and the other M.A., Rebecca, encouraged me to keep going to school until I could be a provider so that they could do my “dirty work” for me. Though my plan is to eventually be a provider, I know I won’t ever take M.A.s for granted because of my experience last week. Providers couldn’t function without M.A.s and it’s true that they do a lot more of the not fun parts of healthcare for them. I have a new appreciation for medical assistants after this experience and I will carry that with me into my career eventually.

I have been communicating with Ms. Otanez for professional reasons for several weeks before starting my internship at UCHC. There were several online courses that I had to take before starting at UCHC, so I emailed her first asking for the links. Then, the links didn’t work so I emailed her again telling her that they didn’t work and asked her if there was somebody else I should contact to access the links. I initiated the communication every time because I was the one having issues on my end. I used electronic communication through email because that is how Ms. Otanez sent me the link and she is not located at my internship site, so I cannot talk to her face-to-face. I managed to resolve the issue using her help and I was able to complete the online courses.

I interact with another intern at mt site, Bailey, quite often just for social reasons. We both really love pediatrics and we bond over all the cute kids we see come into the clinic. Everyday when we come in, we wait in the waiting room until Mrs. Pratt comes out to get us, so last week we talked about what we did for Halloween. I was comfortable during this interaction because she is my peer and I can relate to her. I don’t interact with my other coworkers on a social level quite yet because I haven’t had much time to get to know them. Also, since the clinic is split into a pediatric wing and a family wing, I don’t get to interact with the other wing very much because our paths don’t cross.

At UCHC, the fridge where the vaccinations are stored have a “VFC” stock shelf and a “UCHC” stock shelf. The medical assistant I shadow explained to me that VFC stands for Vaccinations for Children, which is a federally funded program in the United States that provides vaccinations to children who lack health insurance or cannot afford the vaccination otherwise. If a patient has health insurance, she takes the vaccine off of the UCHC stock shelf. But if they don’t, she uses the vaccines from the VFC stock shelf instead.

November 6th – November 19th (16.53) – A meaningful experience I’ve had over the past two weeks was when a woman came into the clinic, and while we were taking her medical history, teared up because the week before she had an abnormal mammogram. She previously had ductal carcinoma breast cancer and was able to be treated effectively. They had found a lump on her breast and she was getting it biopsied a few days after she came into the clinic. She was very tearful while talking about it. It made me a little sad because as much as I want to help people and tell them it’s going to be okay, sometimes you don’t know. I talked about it with the M.A., Rebecca and we agreed that it’s really sad when you can reassure a patient that everything will turn out fine. Through this, I learned that even though you may not be able to reassure a patient about their condition, something small, like getting them a glass of water after they’ve been crying, can make them feel better.

When I was shadowing my pediatrician before I started at UCHC, I did not do a great job at establishing a schedule. I would wait until the last minute to decide which days I was going in and would often have conflicts pop up because I hadn’t planned in advance. However, once I started at UCHC I established a schedule very quickly. My mentor printed a schedule and put in on the fridge in the break room, so all of the staff could when I was planning on coming in. This held me more accountable because other people had to plan their day around me as well. With my pediatrician, she just asked me to text her 30 minutes before I got there, which made it easier to back out of going in. There’s only been one day where I couldn’t go into UCHC since I started and I contacted my mentor right away once I found out I couldn’t make it in.

I think I’ve done a great job so far balancing my schedule. I’ve been using my planner every week and writing out what my schedule looks like on Sunday nights. I plan out when I am going to assignments I know of and then make any small adjustments throughout the week if other assignments come up. During volleyball season, this was more difficult because I did not have as much free time, so I didn’t get as many hours and I probably should have. However, I am making up those hours currently and my internship site is very flexible with how often I am there. I never fell behind on schoolwork, just with hours slightly. During the second semester, I will make sure to not fall behind on hours by planning which days I will be going into the clinic as far in advance as possible. This way, I will know exactly how many hours I should have each week and will easily be able to reschedule if something comes up.

An acronym I recently learned was “FTT”, or Failure to Thrive. Dr. Ramsower allowed me to shadow her during a 9-month-old’s appointment. When I was reviewing her chart, I saw that Dr. Ramsower had listed “FTT” in her problem list. I asked her what it meant and she said it stood for Failure to Thrive, which means she’s had trouble gaining weight her whole life.

November 20th – January 6th (21 hours) –  At my internship, there was a student that was doing her clinical hours for her Doctors of Nurse Practitioning in Pediatrics, which is the same degree I want from the U of A. It was really insightful to talk to her about the program, considering I’ve never had the opportunity to meet somebody doing the exact program I want to pursue. She has two young children and encouraged me that if she could do it with two kids I’d be more than capable of getting the degree. She told me about the importance of researching the professors before enrolling in a program as well. At the U of A, the pediatrics program is very new, so there is only one full time professor who specializes in pediatrics. All the other professors were pulled from other departments at the U of A to teach curriculum that they weren’t necessarily experts on, which she said was frustrating at times. All that said, seeing what she was able to do and how knowledgeable she was even with her academic struggles aside, it made me excited for the future.

Though I don’t ever need to do it by myself, taking blood pressure manually still isn’t something I’m confident at. For this reason, I have made it one of my goals for this semester to practice that skill. I’ve never had to seek out additional resources on the day to day tasks I usually do, but this is something I want to learn just as a skill to have going into the medical field. I plan on using free outside sources that I have found on the internet to teach myself how to take blood pressure manually. There are many helpful instructional videos that I can utilize. I can also use my mentor to ask any questions that aren’t answered by the online resources.

Since this is a current goal, there is so resolution quite yet. I’m sure I will be able to practice at home by myself using a manual blood pressure cuff and comparing that to the automatic machine we have at home. If I get the chance, I would love to also be able to practice in the medical environment on patients if a reading is high and we are required to retake their BP manually. Then, I could get guidance from my mentor on whether what I was able to teach myself lines up with the professional training they received. With this knowledge, I can be more helpful around the clinic if manual blood pressures need to be taken. I will also be more prepared for the next step in my journey towards becoming a nurse and will have a tiny step up on other students when it comes to technical training.

A large part of medical assistants’ jobs is documenting everything that happens with a patient on the computer. They document everything from recent surgeries and the paperwork that came with those, to simple telephone conversations about prescriptions that are ready for pickup. Rebecca always puts the acronym “tcon” in her notes after she talks to a patient on the phone. I thought it was a fancy medical acronym, but really it just means “telephone conversation”.