My site evolution was with Professor Alie where I went over two of my patients with him. My first HPI compared to my third HPI were slightly different as by the third HPI I was much more comfortable with the system and how to do referrals to send out patients. My first HPI discussed a patient who came in with ripping tearing chest pain. I discussed this patient with professor Alie and told him how when the patient first said those exact words, my mind went towards aortic dissection as that is what we are taught in school. So right away I decided to take my patient’s blood pressure to see if there were any variations between both arms, but the patient’s vitals were stable. Throughout my interview, I was not able to get a good ddx for why he was experiencing this chest pain. But as soon as I came to my PE, and palpated on my patient’s chest wall which elicited  pain. I had a much better idea of what my patient was experiencing. I also learned a new diagnosis when trying to discuss the ddx in my site evaluation which was tietze drone which is very similar to costochondritis but presents with edema in th4e area as well.

My last HPI discussed a patient who presented with a burning sensation in his stomach. Based on most patients that come in with this complaint, Gerd is on the top of the differentials. But as I asked the patients more pertinent questions, I started to learn towards cholelithiasis. This same patient was then referred to get an ultrasound done and came back with my diagnosis being correct. This was an important case for my to discuss as I was the primary and my provider had asked me my plan and agreed with my findings. Dr. Alie had discussed with me the importance of asking these pertinent questions because at times patients may be misdiagnosed just based on the symptoms they are stating themselves.