The last month of Geriatrics was surprisingly rewarding. I get so used to the fast pace of inpatient medicine, so shifting to Geriatrics was a new concept because I realized you have to approach the patient differently. I quickly realized that you ask different questions and look out for specific things when seeing a geriatrics patient. For example, I never thought about asking about ADLs or IADLs when doing an H&P, but knowing this will help guide your plan for a geriatrics patient. In addition, one concept I will find useful is the concept of prescribing cascade which involves prescribing medications for symptoms caused by other medications, and I didn't realize how often this happens until I came across this concept. Also, I realized the importance of considering a patients age and life expectancy when it comes to treatments and screenings. It's easy to get in the routine of common recommendations, but it's important to step back and look at the patient as a whole and consider where they are along life's continuum. Finally, it dawned on me that growing old is not easy because many patients are limited on what they can and can't do and things that define them or activities they have enjoyed their whole life may not be possible anymore due to their functional status and as a person who is active and constantly on the move, I can't imagine what it's like not to be able to enjoy those activities. However, almost every patient was accompanied by a loved one or someone who looked after them who worked at making their elder comfortable and safe which is encouraging.
Tuesday, May 7, 2013
As I look back on the last four weeks on the geriatrics rotation, I am amazed at the complexity of the medical management involved in the elderly patient care. As a physician, we have the unique experience to see the many aspects of care from the family members involved, hospitals, long care facilities, home health, and even hospice and the absolute importance in the effective coordination involved in managing all of the aspects of care. During my time time on this rotation, I had the opportunity to visit with many patients and families, all of them so welcomed the care and I never saw any loved one express anger or frustration, even with sometimes devastating diseases that they were dealing with. The history and experience that the older generation has is so important. Just to sit and listen to there stories is amazing. Not only do the benefit from having someone to talk with and relay the experiences, but the insight and value of hearing those experience can not be measured. My greatest hope is that we, as physicians, don't loss the ability to spend time getting to know our patients and their families.