“And I think to myself, what a wonderful world”, sang the volunteer to the group of elderly individuals encircling her. As she continued to sing to the group, I found myself, pen resting on the table, listening and reflecting on the aging population around her. I was on my second nursing home visit and the geriatrics rotation had taught me two great lessons, the elderly population is complex and the goals of treatment are often different.
Medicine’s complexity has always interested me, the chance to investigate someone’s history, their multitude of symptoms, analyze the collected laboratory data, and formulate a plan. The geriatric population amplifies this process due to their atypical presentations and innumerable psychosocial factors, all in the face of a population with differing goals of care.
As a patient ages, the recommendations for screening and treatment change. The evidence based medicine I have so devotedly learned has been broken on this rotation. Each patient requires an individualized plan based on their physical illness, psychosocial components, and their personal goals. For example, is it truly beneficial to pursue colorectal screening in a patient with a terminal illness? More than once, I have had the opportunity to expand my medical thought process.
This rotation not only taught me to enjoy another multifaceted aspect of medicine, but also provided me with a renewed perspective on life; what are the most significant aspects of life and how to define quality of life. Watching the volunteer move throughout the crowd, I caught a glimpse of what my future might be like and reflected on what is most important. What a wonderful world it is indeed.
-- Leanard Riley