Starting my geriatrics rotation, I wasn’t sure what to expect. Many of the people we care for in internal medicine are by definition “geriatric”, so how could this rotation really be much different, right? What I discovered during this rotation is that sometimes taking care of your patients doesn’t mean simply mean ordering the right tests, making the correct diagnosis, and giving the evidence-based medical therapy. There is more to that, especially when dealing with older patients. I found myself looking past the basic medical evidence and instead thinking about what would truly be best for each patient. Maybe that blood pressure medicine, strict diabetic control, or allergy medication is doing more harm than good; or does the benefit of ordering that invasive test really outweigh the benefit in my frail 82 year old patient? No, not every 80 year old is the same regarding their functional status and treating each patient the same is bad medicine.
I also came to realize that looking past vital signs and lab test is necessary to really care for my patients. When someone is falling at home or having a difficult time caring for themselves, the answer is oftentimes not simply in the “results” section of the chart. It is buried in the patients’ history and their home situation. Who is there to provide care at home? What can be done to make your living situation safer? Are there things we are prescribing that are actually making this worse? These are the questions I had to ask myself. In essence, I re-discovered the “art of medicine” and re-focused my treatments to the individual, which is so vitally important in the geriatric population.
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