Running head: REFLECTIVE ESSAY 1

Shenandoah University

Reflective Essay
Katheryn Soto

Submitted in partial fulfillment of the requirements for

PA-579: Primary Care I to Camilla Hollen, MMS, PA-C
August 14, 2017
REFLECTIVE ESSAY 2

The purpose of this essay is to reflect on a patient interaction during my PC1 rotation

considering all points of view: clinician and patient, clinician and self, clinician and colleague,

and clinician and society.

The patient encounter I remember most vividly from my PC1 rotations occurred during

my podiatry rotation in Winchester. My preceptor briefly reviewed this patients case with me

before entering the room. She explained to me that he was an older gentleman upwards of 65,

obese, and long-standing type II diabetic. Due to a history of poor glucose control and inactivity,

he had suffered significant peripheral vasculopathy and neuropathy. For several months, he

suffered from a significant calcaneal ulcer of the left foot that refused to heal. Despite regular

visits to the podiatrist and home health care efforts to monitor and care for the wound, the ulcer

developed a MRSA infection that required removal of nearly half of the calcaneal bone. The

patient presented that day one week post-surgery for wound redressing. When we entered the

room, he told the physician that over the weekend he noticed something with the wound was not

quite right. He checked in to his local urgent care facility where wound culture confirmed that

the area had become re-infected with MRSA and the infection again had reached the bone. The

patient, however, remained optimistic and told my preceptor that the next step planned was to

have a PIC line of Vancomycin administered while in a hyperbaric chamber to try to clear the

infection. Despite his optimism, you could tell that everyone in the room knew that these

attempted interventions were all just a band aid to a complex problem, and that his leg would

likely require amputation within the next year if not sooner.

Later when consulting with my preceptor about this case, I learned that she had not

performed the surgery, and that she was disappointed that her colleague had not placed the
REFLECTIVE ESSAY 3

patient on antibiotic prophylaxis in fear of damaging the patients kidneys any further. Proper

post-surgical prophylaxis could have potentially avoided this problem altogether.

In this encounter, the clinician and the patient have a longstanding well established

relationship. The clinician has a comprehensive understanding of multiple aspects of the patients

past medical history, history of present illness, social and family history and the patient and his

wife openly described details of his recovery as well as photos of their grandchildren. The story

also highlights the importance of relationships between clinicians in providing high quality

coordinated care. If my preceptors colleague had consulted with her before discharging the

patient from surgery, they could have worked together to determine an antibiotic prophylaxis that

would effectively protect the patient from further infection while maintaining the integrity of his

kidney function. Although my preceptor was frustrated with this situation, it was important for

her to practice face management in front of the patient. The provider put her personal feelings

about how the patient was managed aside and did not comment on them in front of the patient

but tried after the fact to contact her colleague to inform him of the patients latest prognosis. It

was evident that the clinician was concerned for the patients well-being. She listened to the

patient and showed empathy for his situation, but she also understood the limitations of what she

can do to help in this situation while maintaining her professional role.

It is important when in practice to be able to see all sides of a patient situation. This

along with face management in front of patients and fellow colleagues will be important skills

for me to develop as a future health care professional.