PERFORMANCE PORTFOLIO OF

Anna Anjelica R. Sanchez

UNIVERSITY OF THE EAST

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC.
DEPARTMENT OF PREVENTIVE AND COMMUNITY MEDICINE
Community Medicine Clinical Clerks Rotation
(March 2016)

EXPECTATION SETTING
As a clinical clerk, I have several expectations for this rotation. First of all, I expect that with this rotation,
we would fully understand how it is to be a public health physician and that how we could help the
community not only as a clinician but also as a community organizer. In out previous rotations, we have
seen how it is to handle individuals and the thought of being a health advocate in a larger scale has always
been an abstract notion. With thus rotation, I expect that we would have a clearer picture of our role as a
community mobilizer. I expect that we would be able to finally understand our tasks and responsibilities.
Since we also have school and clinic rotations, aside from the community exposure, I expect that we
would be able see cases and learn how to manage these cases as a general practitioner with clinical
practice guidelines and the principles weve learned in medical school as bases for the management we
would prescribe. As for the school rotation, I expect that it would be more on the health advocate side as
we would teach these children topics on health promotion.
I have previous experience in community immersion and community organization back when I was a
student nurse in Saint Louis University. Our assigned communities back then were in Kapangan and
Buguias Benguet. It was a memorable experience because the immersion was exactly what was discussed
during the lectures. We would stay there for 3-4 days straight and do home visit and case finding every
day. We also aided in identifying key persons within the community. We would visit at least 20 houses per
day and do the interview while helping them with the planting or harvesting or whatever it is they were
doing at the time of the interview. At the end of the rotation we came up with a Community Diagnosis or
a Community Development action plan depending on what the community needs. Since I have a past
experience with a rural community, in addition to what Ive mentioned above, I expect to see the
difference between community exposures in an urban setting as compared to a rural setting and see how
each on is to be approached and managed?
COMMUNITY SUBROTATION
Our visit to the tenement housing was an experience which showed me the sad reality of urban housing
for the poor. During our short visit, I was able to see several health risks and hazards at the area such as
the presence of vermin and rodents, poor waste management and weak floors and the absence of rails.

For our community subrotation, our activities mostly included case follow-ups and new case findings. On
the cases weve followed up, they were mostly hypertensive and diabetic patients with maintenance
medications. One of the problems weve seen is compliance with the medications and the lack of regular
BP monitoring. Poor compliance was either a result of financial incapacity or a result of sheer
stubbornness. Since compliance is crucial in the management of hypertension and diabetes, as physician it
is important that we explain the reasons for the medications we prescribe, the possible side effects and
what would happen if they just suddenly discontinue the medications without consulting. I believe that
once a patient fully understands the nature of his condition and the reasons behind each therapeutic or
diagnostic procedure, compliance would follow. We must make sure that whenever we explain, we shy
away from too much medical jargon and use terms which the patient can easily comprehend. We must
also adjust the way we explain based on the patients educational attainment and level of understanding.
We should also watch the way we phrase our explanations because people tend to take things differently.
We should first assess what the patient wants to know and how much he can take. If needed, explanations
could be give in an installment basis especially if they think that a concept would be too much for them
grasp and comprehend. It is also important that we take into consideration the patients cultural and
religious beliefs for this would greatly affect compliance.

CLINIC SUBROTATION
For our clinic subrotation, we only had one patient at the clinic during our 10-day rotation and it was a
probable case of nephrolithiasis. While managing this case, Ive seen the value of a good history and PE.
Although this was pretty much a straightforward case, it is good to see textbook cases every now and
then because it reinforces what weve read in the books. We were often told that each patient is different
and patients rarely present as typically as the books would project it to be. However, with these kinds of
cases, we apply what we know and because weve already seen the classic picture it would be easier for
us to identify any deviation in the symptomatology or temporality of a case. It makes us better clinician
because we become more open minded as to the different possible presentation of a supposedly simple
and straightforward case.
During with this subrotation, we were also able to practice our skills in blood extraction on buth adults
and pediatric patients. The younger patients were especially challenging because you not only have to
console the patient but the parent as well. Again, this shows the importance of a good patient-doctor
relationship and the importance of good communication in the practice of medicine, especially pediatrics
where you are not only catering to the patient but the family as well.

SCHOOL SUBROTATION
The school subrotation is the subrotation which I best enjoyed. During this exposure, we conducted
lectures on proper nutrition including the food plate and food substitutes. I was in charge to do the
presentation for the eat this! not that! portion of the lecture and it was particularly challenging to come
up with healthy food substitutes which are cheap and easily accessible to these children. The kids
reactions during our lectures were really something to see. I realized that like me, they know the theory
but the temptation of sweet, salty and fat food sometimes overrides my better judgement. During these
sessions, I saw several misconceptions which are consistent in every class weve taught such as softdrinks
causing UTI and that they should stay at home playing with their gadgets rather than playing outside. I
believe that these misconceptions should be corrected but the right people to correct are the parents and
teachers who will then teach the children. The kids questions were also both funny and difficult to
answer such as one who asked why his mother kept feeding him with processed foods everyday when
processed foods are not really that good for growing kids. It was challenging to answer these kinds of
questions with tact and without undermining the parents credibility but I realized that there is a way to do
it and that is to try to compromise like by saying, yes, it is processed food and may not be healthy for
you but eating these foods occasionally and in small amounts can be done.

In thus subrotation, I have seen the importance of teaching health promotion early. When then minds are
still open to ideas. It is indeed easier to plant new seeds of knowledge than to correct wrong practices and
misconceptions.

FAMILY CASE STUDY

For our family case, weve managed to follow-up several families and found one new case. During these
home visits, we inquired about the health of the sick person and inquired if other people in household are
also sick. We gave health teachings and advised on home care yo patients and relatives especially those
with members who are severely ill and bedridden. We instructed them on how to avoid the complications
of prolonged bedrest and how to avoid aspiration during feeding. It was remarkable to see that most of
them were being cared for well by their relatives. We also tried assessing for caregiver burden in those
with terminal conditions such as our patient with lung cancer who was severely cachectic. The care given
by the son to his father was really something. The patient was clean, fed regularly and had no bedsores.
He was also doing passive range of motion exercises with his father and you can hear from his voice that
he was determined to help his father survive. As a medical practitioner, we knew that this was impossible
but since the family is doing its best to care for their ailing father, we could only teach the, ways on how
to make their father more comfortable and to prevent the complications of prolonged bedrest.

In the course of our family case studies, I have learned the importance of gaining cooperation from the
family in managing a patient. I realized that their role in the patientss physical, emotional and mental
well being is crucial. Their help in ensuring that the patient is compliant with the prescribed treatment
regimen and that the patient does not become depressed makes a significant difference whether the patient
will survive or not. His family and support system will greatly determine on how the disease would
impact his quality of life during and after the illness.

END-OF-ROTATION INSIGHTS AND FEEDBACK

From this one month rotation, the most memorable experience would be teaching the kids in the school
and doing home visits. The kids were very active and interested in the discussions and their questions
were really stimulating. As for the home visits, the people we interacted with were interesting. Each one
has a story to tell and the journey itself to the different houses showed me the sad state of the urban poor
with the overwhelming number of health risks and hazards in the community which needs to be addressed
by the local government and health officials immediately.
In this rotation I have learned the importance of good communication and adaptability in caring for the
patients. It is not enough that one knows the principles. As a medical practitioner one should be able to
explain it to the patient and have the patient understand his condition and treatment regimen. Also, in
setting such as these where resources are scarce, one must learn what tests to prioritize and other possible
treatment substitutes which a more financially friendly to the patients.

In my opinion, I was able to make a great impression on the few people Ive interacted with. The
childrens eager participation in the classes showed me that they were really willing to learn amd are
ready to apply it in their daily lives. For the patients, their expression of willingness to practice what was
advised to them was temporary goal met for me because the improvement in the health in the long run
would determine whether Ive really made an impact on them.
As for my recommendation, I suggest that more time would be spent on the community subrotation and
less on the clinic. Since we have very few patients at the clinic, the clerks would learn more in doing
follow ups and family case studies rather than merely idling away waiting for patients which are few and
not enough to cater to the learning needs of the all clerks in that subrotation. Since there are many sick
patients in the community who are not regularly seen by health practioners, more time on the community
subrotation would not only be beneficial to the clerks but the patients as well who could not afford the
services of a private practitioner.