History and physical write up
Journal Article with a short summary of the article
This study investigated whether antibiotics improve outcomes for patients with small, uncomplicated skin abscesses after standard treatment with incision and drainage. The researchers conducted a multicenter, randomized, double-blind, placebo-controlled trial involving 786 adults and children with abscesses 5 cm or smaller. Participants were randomly assigned to receive clindamycin, trimethoprim–sulfamethoxazole (TMP-SMX), or placebo for 10 days following drainage.
The results showed that both antibiotics significantly improved cure rates compared with placebo. Clinical cure occurred in 83.1% of patients treated with clindamycin and 81.7% with TMP-SMX, compared with 68.9% in the placebo group. The benefit was primarily seen in infections caused by Staphylococcus aureus, including MRSA. Clindamycin also slightly reduced the likelihood of recurrent or new infections at one-month follow-up compared with TMP-SMX.
However, adverse events were more common with clindamycin, mainly gastrointestinal symptoms such as diarrhea. Overall, the study concluded that adding antibiotics (clindamycin or TMP-SMX) to incision and drainage improves short-term outcomes for uncomplicated skin abscesses, but clinicians must balance the benefits with potential side effects and antibiotic resistance considerations.
Site Evaluation Presentation Summary:
During my site visit I presented on a 51 year old male with history of type 2 diabetes and hyperlipidemia presents with erythema and pain across his entire left groin which is described as sharp and increasing for the past two weeks. The patient first noticed redness in his left groin 2 weeks ago after shoveling snow in tight sweatpants. The pain worsens when he touches his left groin. On physical examination, the patient has large dark discolored area to left inguinal region with surrounding induration and tenderness. I discussed my plan for the most likely diagnosis, a groin abscess, which involves ceftriaxone, and incision and drainage. I received positive feedback for my presentation especially for how it showed the pertinent positives. Changes I plan for future site visits would be to not include medical terminology within the HPI section of my history and physicals since it should be in the patient’s words such as redness not erythema
Typhon Postings
Reflection on the rotation
Something new: A new technique I was exposed to was deep dermal suturing, subcuticular suturing, and hand tying sutures. At first, I had difficulty learning these suturing techniques because I was not taught these during the didactic year of the program, however, after multiple times of practicing after asking if I could suture at the end of cases I was able to become good at these suturing techniques. Another new technique I was exposed to was calculating urine outputs which was new to me as I did not learn about this during the surgery course in didactic year. I was able to learn this technique quickly as it involves simple multiplication and division.
Skills, challenges, and action plan: I realized how different people of the same job title in healthcare can work from each other and an important interpersonal skill is to recognize and respect their boundaries. For example, I have come across surgical technicians who appreciate you passing surgical instruments from their hands into the physicians but I have also come across a surgical tech who preffered to stand right next to the attending physician, and watch the surgery and pass the instruments directly to the physicians. A situation that I felt was difficult at first was presenting only information which surgery considered important, for example characterizing bowel movements and calculating urine outputs. I improved by listening to the residents’ feedback and applying what I learned into my next presentation. The types of patients I found to be challenging in this rotation were communicating with patients who did not speak English well and how important it is to have a medical interpreter accesible, fortunately, the hospital did have access to an app that allowed healthcare workers to directly connect with a medical interpreter. A skill that I would like to improve on is presenting patients to providers in a way that is concise while also including pertinent positives. An action plan I have for this is to continue to practice writing presentations and presenting patients to providers in upcoming rotations so that I will feel confident and improve in this important skill.
Memorable experiences: A memorable experience I had was following a patient with a recent diagnosis of colon cancer from his admission to his surgery to his discharge. I felt being a part of his medical care and seeing his recovery reminded me of the humanity and vulnerability of medicine. The knowledge I gained from this rotation is that I have although I have made large improvement in my presenting skill I can still improve upon identifying pertinent positives.
Overall reflection and perspective: This rotation not only taught me how much I still have to grow in my medical knowledge and medical presentations but made me self reflect on my personality. It is important to be proactive as a student because it not only allows me to learn the most I can out of these rotations but the most important reason for being proactive is that it allows me to advocate for my patients and the care they deserve. One thing I would want my preceptor and colleagues to notice about my work during this rotation is my effort to grow from the mistakes I made at the beginning. I sincerely apologize for the unprofessionalism I displayed. Although this was only my second rotation, that is not an excuse for the negative representation of myself and my program. I hope that over the course of the rotation I demonstrated humility, accountability, and a genuine commitment to improving both my medical knowledge and myself as a person.
Procedure logbook with signatures:
