Over this rotation I had two site evaluations over which I presented 2 patient cases, a journal article and 10 drug cards. The mid-site evaluation was held on zoom. I was the only student at this meeting and I presented a patient who came in with bilateral pulmonary embolisms and multiple DVTs of the RLE at the age of 50. I found this case interesting because I had never seen a PE before, and also because this patient was so young who developed many clots with no known cause. We discussed possible causes of clotting, including hyper-coagulable states such as antiphospholipid syndrome and occult cancer, which is required in the workup of such a patient.

The final site evaluation was in person along with one of my classmates. I particularly enjoy having these meetings with other classmates because I get to learn about their patients and diagnoses. I presented a case that covered a sensitive topic that taught me a lot about how to deal with challenging patients and scenarios. The patient came to the hospital requesting opioid pain medications due to post op pain. This was a patient who had a long standing history of using opioids for pain control who admitted to being addicted to the medications. I was speaking to the patient on my own and decided the best course of action was to try to explain to him why we have to be cautious with these medications in addition to validating his frustration in not having them prescribed and his pain. During the site evaluation we got to discuss how to deal with situations like these when they arise and the complexity of the field of pain management. We also discussed the importance of checking Istop, how to interpret the results of Istop and the recommendations that pain management made for this patient.

During my final site visit I also discussed a journal article that studied what behaviors made physicians more suspicious of drug seeking behaviors. The most important factor they looked into was whether active requests for specific opioids raised suspicion as opposed to passive request of something for pain control. They found that active opioid request made physicians more suspicious of drug seeking behavior, but that did not prevent them from giving the medications. Some strategies they chose to use was to decrease the dose and supply of the medication. This idea tied back to what we discussed during the meeting regarding the complex nature of pain management.