Site Evaluation Summary 

Patient presentation: “A 51 y/o Hispanic female with PMHx of Asthma presents to the ED with complaints of swelling along her entire right 4th digit x 5 days.”

For my site evaluation, I presented my third H&P which is a case of a woman who came to the ED with complaints of pain and swelling in her finger. More information on the case can be found in my “H&P3”. This case was quite an interesting one as there was a debate between the resident and myself about whether the swelling and pain may have been the result of an abscess rather than a severe case of flexor tenosynovitis. Ultimately the swelling was diagnosed to be the result of an abscess.

During my presentations at the hospital and at my site evaluations, I noticed that I had a pattern of being fixated on a particular diagnosis (one that I have a higher suspicion of) and in so doing would not fully consider all the other possible differentials that could also be attributed to a patient’s complaint. This was also noted in some of the feedback that I received from my site evaluator. My evaluator encouraged me to try expanding my differential diagnosis list and to be careful to include those that may be associated with very negative outcomes and risks for the patient. I agree with this feedback and next time will try to be more aware of this moving forward.