Reflection on Rotation           

I had a feeling I would enjoy Family Medicine as really enjoy educating patients and building relationships. I saw several of the same patients for follow-up in the last week of my rotation that I had seen the first week which was wonderful to see the story full circle. I enjoyed the fast-paced environment of Dr. Dairo’s office but do wish there was more access to certain tests. My ideal environment would be a bend of urgent care-like testing with quick results combined with family medicine follow-up for complete care of patients. I was able to see the hypertension medication and cancer screening recommendations so many times that they are now second nature to me. I was not surprised by the number of referrals made to specialties and I know this is very important but for myself, I found that I wanted to know what it was on the spot. I would love to get more experience in dermatology, rheumatology, and orthopedics. I used a lot of information learned in Professors Herel’s class “Primary Care” which focused on work-ups for common complaints and can’t miss diagnoses, red flags and physical exam findings. Once again Professor Herel’s teaching is very applicable, useful and helped me feel and look very prepared for multiple scenarios. Dr. Dairo made me feel like part of the team, I felt very utilized and felt like I made a difference in multiple patients’ lives. This was a fulfilling rotation for me.

Article Summary:

I chose this systematic review published in World Journal of Surgical Oncology, systematic review as it addressed the relative risk and accuracy of transperineal prostate versus transrectal prostate biopsy. My patient in my H&P had a prostate biopsy done transrectally and developed a complicated UTI, prostatitis and had to be hospitalized. This systematic review looked at 11 studies and condensed the relative risk and accuracy of these two different procedures. Tranperineal prostate biopsy has the same diagnosis accuracy as transrectal biopsy and significantly lower risk of infection and rectal bleeding. The article also discussed the great number of patients underwent an unnecessary prostate biopsy due the low specificity of  Prostate-specific antigen (PSA) screening. Therefore, a procedure with the least amount of risks is very important if the biopsy could be unnecessary. PSA incidence was estimated to have a false negative rate up to 49%. Due to the high false negative and complication rates of the systematic TR prostate biopsy, the TP approach was introduced to improve the detection rate and safety of prostate biopsy. Especially in patient who are prone to infection including those with diabetes, prostatitis, and urinary catheterization, the transperineal prostate (TP) biopsy was recommended to avoid sepsis and severe fever after the procedure. The TP approach was confirmed to be superior in detecting tumors in the transitional zone and apex of the prostate

Site evaluation Summary

            We talked about how the patient I did my H&P patient did not have the diagnosis of benign prostate hypertrophy (BPH) but they had urge incontinence and were seeing a urologist for a high PSA. My site evaluator Fahim stated that he probably had BPH even of there wasn’t a diagnosis or tamsulosin prescribed. We also discussed how there is a decreased learning curve for transrectal biopsies but how in my opinion this should not be the reason why they are the more chosen routine in the US when they have a higher risk for complications. My site evaluator reminded me that cost plays a huge factor in the US with transperineally having more set up costs. We discussed the populations I was working in, the insurance and the subsequent decreased access to the cutting edge of medical care in the US. I would educate patients on the two different types of biopsies, the risks, complications and tell them to discuss with their urologist. For myself and my loved ones, I would advocate for the best care which in my research would be for their prostate biopsy to be done transperineally.

I did two versions of my OSCE, one abbreviated and one with explanations for why tests are done