At the site evaluations for the ambulatory care rotation, I presented three H&P’s regarding patients I had seen at the urgent care. It was a challenge to find interesting cases to present in the first week as most patients presented to urgent care for Covid-19 testing or vaccine administration. I was lucky enough to see a patient who initially appeared to present with a pulmonary embolism. The patient was subsequently examined, and it was revealed that the patient had Covid-19 infection mimicking signs and symptoms of pulmonary embolism and met PERC criteria, ruling out the initially suspected diagnosis. This is one of the H&P’s I wrote up and presented an article on, as I found it fascinating that Covid-19 can present so similarly to pulmonary embolism.

The feedback I received on my H&Ps included documenting the use of clinical decision-making tools such as PERC criteria and inquiring about family history. This was helpful as I often forget to ask about family history in a setting like ambulatory or emergency care. Family history can be the missing piece of the puzzle when evaluating specific patient presentations. Documenting the use of clinical decision-making tools is also valuable as in can aid in justifying a treatment, continuity of care, and any legal issues that may arise down the road. Overall, I was able to write H&Ps that focused on the presenting complaint but also included a number of different possible differential diagnoses. I feel that I was able to thoroughly cover the pertinent details while keeping the H&P’s focused as is appropriate in the ambulatory care setting.

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