My Experience with PaJR and Remote Learning

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Greetings! I am Sanjana Palakodeti, a medical student from Kamineni Institute of Medical Sciences, Narketpally, India. In this blog, I aim to share my experiences and challenges faced during my journey in forming an accurate clinical diagnosis during patient care. 

During my medical education, I have come to realize that the accurate diagnosis of a patient's condition can open the door to many specific treatment options. Each patient's unique case presents a puzzle to solve, and it requires thorough investigation and analysis to reach the correct diagnosis. 

My journey with patient interaction began during my second year of MBBS when I was introduced to the clinical setup and started interacting with patients. Despite the challenges posed by the pandemic, I continued to engage with patients remotely, taking their history over the phone, and documenting their case blogs. This experience allowed me to provide medical care to individuals who previously had limited access to healthcare services.

CBBLE and PaJR are two valuable tools that have aided me in this journey of "remote healthcare".

CBBLE, which stands for Case-based blended learning ecosystem, refers to an educational approach that combines case-based learning with blended learning methods in the field of medical education. It is designed to provide a comprehensive learning environment that incorporates various learning modalities and serve as the foundation for students to develop clinical reasoning skills, problem-solving abilities, and critical thinking.

PaJRs , or Patient Journey Records, PaJRs aim to provide a detailed account of a patient's healthcare journey, including their medical history, diagnoses, treatments, medications, test results, referrals, and other pertinent information.They facilitate continuity of care by ensuring that all healthcare professionals involved in a patient's treatment have access to relevant information. Moreover, PaJRs empower patients to actively participate in their healthcare decisions. By having access to their own records, patients can better understand their medical history, track their progress, and collaborate more effectively with their healthcare team.

Each case I encountered through CBBLE added to my knowledge and exposed me to the vast variability of medical conditions and their management. I faced diagnostic and therapeutic challenges with every case, and through collective discussions with experts, I gained insights into evidence-based best practices.

One of my initial cases involved a 48 yo male with bilateral pedal edema, facial puffiness and itching. He was diagnosed with iatrogenic Cushing's syndrome secondary to drug abuse. 

https://96sanjanapalakodeti.blogspot.com/2021/07/a-48-yo-male-with-bl-pedal-edema-facial.html

Another case that had a profound impact on me was that of a 37 yr old female. We had interviewed the patient on call. This patient had a number of psychological symptoms as a result of her circumstances and emotional abuse. These psychological symptoms had started manifesting physically too. Though there was no medical help we were able to provide for her, we had engaged in a conversation for more than 3 hours, where she described all the issues she was facing. This helped her feel better and much more hopeful towards the end of the call. Through this experience, I learnt 3 things - the difficulties that may be faced while taking history over the phone (diversion from the main topic, less chances of understanding the patient's symptoms, etc.), the importance of a strong empathetic connecting with the patient in order to gain their trust, and how profound of an impact the psychological state of a person can have on their physical health. Unfortunately, this patient did not consent to have a blog or a PaJR group. 

The most recent case in which I was heavily involved was that of a 47 yr old man with involuntary hand movements. This initial consultation for this patient occurred telephonically. After that, a PaJR group was formed where the patient's daily symptoms were discussed and analyzed. Any questions that the patient had were answered as well. The discussion in the group encouraged the patient and their advocate to travel to the hospital in order to consult a visiting genetic specialist. Their testing also motivated their relatives and children to get tested at their own place. Finally, he was diagnosed with Huntington's chorea, and family counselling was given. 

https://96sanjanapalakodeti.blogspot.com/2023/01/47m-with-involuntary-hand-movements.html

In conclusion, my journey with CBBLE and PaJR has been transformative. It has enabled me to provide medical care beyond the confines of the hospital, connect with patients, and contribute to their well-being. I am grateful for the learning opportunities these approaches have provided me, and I look forward to further growth and exploration in the field of medicine.

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