I completed my family medicine rotation at Devicka Persaud PC from September 30 to November 2024, I participated in a comprehensive site visit evaluation conducted by PA Fahim Sadat. This evaluation session included several classmates and required us to present complete History and Physical (H&P) reports, engage in pharmacological drug discussions, present patient management cases, and review a journal article.

PA Sadat provided constructive feedback on our cases, emphasizing areas for improvement while also taking the time to inquire about our experiences during the rotation and whether we felt it was going well. One of the case discussions prompted us to explore the mechanism of action of GLP-1 receptor agonists, highlighting their increasing off-label use for weight loss among patients.

We discussed how GLP-1 receptor agonists slow the gastric emptying process, leading to reduced rates of glucose absorption and lower postprandial blood sugar spikes, which contributes to better overall glycemic control. These medications enhance glucose-dependent insulin secretion from pancreatic beta cells; when blood glucose levels rise, they stimulate the pancreas to release more insulin, thereby helping to lower blood sugar levels. However, we also acknowledged potential risks associated with GLP-1 agonists, including an increased risk of aspiration and pancreatitis.

Additionally, we examined the clinical challenge of spinal tumors, which are often missed in patients presenting with back pain. PA Sadat encouraged us to include this condition in our differential diagnoses when evaluating back pain complaints. We also highlighted that taxi drivers are particularly prone to constipation, which can lead to hemorrhoids and lower back pain. He underscored the importance of performing a rectal examination when patients present with chief complaints of back pain, as this can help identify underlying issues that may otherwise be overlooked.

In our journal article discussion, I presented findings that demonstrated significant benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing all-cause mortality, cardiovascular mortality, non-fatal myocardial infarctions, and kidney failure. These discussions not only enhanced our clinical knowledge but also underscored the importance of comprehensive patient evaluations and the consideration of lifestyle factors affecting health outcomes.

Overall, the site visit provided valuable insights and reinforced the significance of thorough clinical assessments and ongoing education in managing complex patient presentations.