During my site evaluations I presented 3 H&Ps, 10 drug cards, and a journal article. At my first site visit the patient I presented was from my second week during GYN-call. We were called because the patient had a recent cesarean, however the problem was musculoskeletal and OBGYN causes were ruled out. The feedback I was given at the time was to broaden the differential. The pharm cards I presented at the first site visit were all drugs that I saw used in L&D. All of the drugs were used in some way during the labor and birth process. Some of the drugs were used to induce labor, another to delay labor, one for pain associated with labor.

At the second site visit the pharm cards were more drugs that I saw used in clinic including antibiotics, antifungals, and contraception. When comparing my pharm cards with another classmate I was unsurprised to see that we both researched and defined many of the same drugs used during labor and birth. Some combination of these medications was used on nearly every patient at L&D and they were all unique and unfamiliar. At this site visit I also presented 2 H&Ps, the first was a patient with cholestasis of pregnancy who needed to have induction of labor and the second was a patient with menorrhagia suspected secondary to copper IUD. My journal article aimed to more closely define side effects due to copper IUD as well to help me understand that patient’s condition better. With the first patient there wasn’t a lot of ability to work on broadening my differential, she had her diagnosis and induction of labor was done due to risk of adverse fetal outcomes.  The second patient I believe I did a better job of broadening the differential. This patient had a few different complaints and pertinent history that needed to be assessed and worked up.

Going forward I plan to continue to broaden my differential when possible as well as things I was working on from last rotation including a more thorough PE.

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