Patient Dynamic



Last week I wrote about my experiences working at the new community health center and the workflow of the facility. However, I did not discuss my patient population.

I automatically assumed that the majority of my patients would be of low socioeconomic status since the facility is a community health center. That is not necessarily the case. Only a quarter of the patients are self-pay or sliding scale fee patients. The majority use private insurances or Medicare/Medicaid.

Before coming here, I was informed that a lot of the patients would be migrant farm workers. I thought this would be interesting since I did some research on them while I was in nursing school at Florida State University. I have always enjoyed helping underserved populations.

So half of my patients are Mexican migrant workers and the other half are white Americans. This is different compared to my patient population in Miami, which were majority Cuban. Most of my patients here are young, ranging from 2 weeks – 25 years old, or middle-aged 35-50 years old. I do have a handful of elderly patients, but nowhere near as many as I did in Miami. Most of my patients in Miami were elderly, whereas here there is a large pediatric population.

My first week working, I immediately learned the dynamic of my patients. For example, I prescribed a muscle relaxant for a patient with back pain. I saw he was self-paying so I told him that he could get it for $4 at Walmart. He told me Walmart is too far for him (20 min away) due to the cost of gas. Luckily the clinic and pharmacy have a program allowing him to purchase the medicine from them for only $8.

I have a lot of children coming for well child exams before they start school. At first I was worried about being competent in this age group but as with anything else, the more children I saw, the easier it got.

For instance, whenever someone says they have a sore throat, they always think it is strep throat. Treating an older patient population in Miami, I have never seen a positive rapid strep test (since strep is more prevalent in children). Strep throat is a more severe type of sore throat because if untreated with specific antibiotics, it may cause other organ complications later in life. Treating a lot of children here, I am more alert to strep throat symptoms.

One day I had 3 positive strep throats within 6 hours. Another day, a child came in for a wellness exam, but I noticed on his vital signs he had a fever. Through my examination his throat appeared red and his tonsils were severely enlarged. I asked the child and his mom if he was sick, they said no. I asked if he has a sore throat and he said a little starting that day. Although my shift had already ended, I decided to go with my gut and order the rapid strep test, since he had no other symptoms except sore throat and fever (classic strep). His results were positive and I treated the patient accordingly. I am glad I provided the care that he deserved.

I am so accustomed to knowing my patient population so well. So that whenever they come it is for a brief visit, as I already know everything about them, and they are just following up with their chronic illnesses. Here I mostly see acute visits and obviously all of the patients are new to me.

I have never enjoyed maternity or women’s health. I cannot exactly pinpoint what about it has always kept me away, but it started since I learned nursing in high school. I guess I always just thought it was gross (so mature I know). Anyways, here I find myself doing a lot of pap smears and even offering them to patients that are overdue. It turns out that it really isn’t a big deal. However, I think I will stay away from maternity 😉

I think having previous experience is helpful working here because I am competent in various diseases management. For example, in Florida, fungal skin infections are common due to the humidity and people are always sweating. Here they are not as common so they are often misdiagnosed as an allergic reaction or eczema. So I admit that it is a great feeling to tell patients that it is a fungal rash and when the treatment I ordered improves their rash, they become confident in me (especially as a new provider they are not accustomed to).

At the same time, I do enjoy being able to see different things I did not commonly see in Florida. But due to my overall background and experience, I am still able to identify and treat accordingly. For instance, gallstones are more common in white women in their 40’s. As I mentioned previously, my patients in Miami were way older than that, so gallstones wasn’t that common with them (a lot of them had their gallbladder removed decades ago). One day I had a patient here with severe right upper abdominal pain. She did not have any other symptoms (nausea, vomiting, diarrhea, constipation, fever) as a lot of the other patients do when they have the stomach virus/gastroenteritis. In my physical exam, she had a positive murphy’s sign which indicated potential gallstones. I ordered her a stat ultrasound and it confirmed my suspicions. I referred her to general surgery and she was scheduled for surgery the following day.

I think one of the reasons I am enjoying my time so much working at this facility is because it challenges me. Working at the same site for a few years, you obviously become an expert in your field. Yet there is no progress without being challenged.

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