 Reflect on the 3 most challenging patient encounters and

discuss what was

1-The first challenging experience was with a Hispanic patient who did not speak nor understand English. She refused to allow me to examine her even when offered to use the medical translator on the iPad. She insisted to be examine by my preceptor whom she is familiar with and who speaks Spanish. My preceptor intervened to convince her to let me examine her but the patient declined. She also insisted that I stayed out of the room during her exam. We respected the patient wishes without judging her. The patient was experiencing severe depression and did not feel comfortable opening up to me.

2-The second challenging encounter was with a patient who complained of waiting too long to be seen. She presented for Depot-Provera shot. The patient that we saw before her had some complications and needed to be transferred to the hospital for emergency delivery because the baby’s HR was too low. We explained to the impatient patient the reason for the delay and apologized. She stated that she was going to be late for work. We gave her a doctor’s note to justify why she was late for work.

3-The third patient was presents every 3 to 4 months with bacterial vaginosis for multiple antibiotic refill. She stated that she did not want to keep coming to the clinic for the same thing. We explain to her that her request cannot be granted because we want to make sure that we were treating the right

disease.

 What did you learn from this experience?

I learned from the experiences to reserve my judgment and be open to communicate and understand the reasons behind any challenging patient. The first patient did not feel comfortable opening up me because she was meeting me for the first time. She had not established a relation with me. A provider and patient relationship is fundamental in clinical care. Good patient-physician relationship are linked to a better patient outcomes

( Honavar, 2018).

.

· What resources did you have available?

The organization has a good translator system with real profession on the iPad because the majority of their patients is Hispanic. They also have a program to assist employee manage difficult patients and security available to protect staff from potential violent patients. Most of the staff at the facility

are bilingual ( English and Spanish).

· What evidence-based practice did you use for this patient?

Declining to prescribe antibiotic without a confirmed diagnose. I refused to refill the third patient antibiotic without a definitive diagnose. Using antibiotic inappropriately can cause resistance and adverse side effect ( King et al ., 2018).

· What new skills are you learning?

I am performing breast exams and pap smear with lesser supervision. Identifying bacteria, yeast , or trichomoniasis under the microscope is still

very challenging but will definitely improve as we go through the quarter.

 What would you do differently?

I will work on my communication skills with patients of different background. Our patient population is mainly Hispanic. In other to achieve a better outcome for our patients, we must implement cultural competency because it emphasizes the need for provider to consider a patient’s background,

culture, ethnicity , race when providing care (Hawley et al., 2017).

· How are you managing patient flow and volume?

Managing patient flow and volume is important for the patients, providers , and organization. For the patient, it prevents delayed of care, anxiety; for the provider, it reduces stress, and burnout. As for the organization, it maintains quality of care and sustainability ( Kreindler, 2017). One way to manage patient flow and volume is to limit overbooking , avoid double booking, and provide adequate staffs.

Respond to the following reflective questions:

· How might I improve on my skills and knowledge, and how to

communicate that back to my Preceptor?

Providing care to a difficult patient requires a lot of patience and self-control to prevent our emotion to overshadow our professionalism. Understanding patients background and culture is necessary to overcome some of the challenging encounter with some patients. In terms of skills like performing pap smear, diagnosing using wet mount, more practices will improved my

skills.

· How am I doing? What is missing?

I am improving day by day and more sensitive to the patients culture. What is missing is the communication barrier in Spanish. I started learning basic Spanish with Duolingo.

 What type of feedback am I receiving from my Preceptor? Gynecology may seem challenging to you now because of your clinical background but with time you will get better. The routine is the same and the more you practice, the better you will get. My preceptor is allowing me to lead in examining patients and assist me as needed.

References

Hawley, S. T., & Morris, A. M. (2017). Cultural challenges to engaging patients in shared decision making. Patient education and counseling, 100(1), 18–24. https://doi.org/10.1016/j.pec.2016.07.008

Honavar S. G. (2018). Patient-physician relationship – Communication is the key. Indian journal of ophthalmology, 66(11), 1527–1528.

https://doi.org/10.4103/ijo.IJO_1760_18

King, L. M., Fleming-Dutra, K. E., & Hicks, L. A. (2018). Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ (Clinical research ed.), 363, k3047. https://doi.org/10.1136/bmj.k3047

Kreindler S. A. (2017). The three paradoxes of patient flow: an explanatory case study. BMC health services research, 17(1), 481. https://doi.org/10.1186/s12913017-2416-8