Seeing as I have a few days to myself in the midst of CaRMS madness, it’s time to revive this dead blog, huzzah!
This was ages ago, but I did a few weeks in geriatrics that I should probably tell you about. Because that’s what I do. Update you all on my life. (Speaking of which, CaRMS post in the works soon as I catch up with my roundups!)
If you’ve never worked with the elderly population, you definitely should. As a general rule, time wears down the rough edges we acquire in the ups-and-downs of youth. Ergo these people are usually lovely, kind, and have a myriad of fascinating tales about their life. This isn’t always true, of course, but even those who are a bit pricklier usually have a good story to explain why that is.
Do enjoy this roundup.
The where: Misericordia
The good: Geriatricians have a wonderful, holistic, whole-person approach to how they practice. Every consult requires you not only examine their (typically ++ complex) medical history, but also their cognitive function and psychosocial history to obtain a thorough understanding of the patient’s life. Especially in patients with dementia, it’s absolutely necessary to address every one of those points and the same for their caregiver or partner – the last thing you want to do is have a forgetful moment where they try to walk without their aid and they fall. So I really appreciated taking all this into consideration where I’ve seen it skimmed over or forgotten on other occasions. As well, like I said, I got along pretty famously with most of my patients. They seemed bemused that I, some kid, was attempting to provide health care, but tolerated me just fine. And similar to other rehab-focused wards, geriatrics is a very team-based specialty, where all the allied health personnel are equal to or greater than the effect of medications we can give in terms of quality of life.
The not-so-good: In a word, consults. This may be site-specific, but the consult service had the potential to be abused. These are comprehensive assessments. They can take a pro up to 45 minutes to complete, so you can imagine it takes a few hours for a newbie like me, largely because of the need to collect collateral history from family, other physicians’ notes, etc. So when the assessment team gets a consult without a real clinical question or just as a way of off-loading their patient list, it’s hugely frustrating. And of course, the fragile and forgetful brain is easily frightened, and it’s distressing to see how some folks with dementia live in a near-constant state of fear and anxiety. It’s not hard to see why some caregivers burn out.
The verdict: This is a population I love working with, though it has its challenges and difficulties like many other specialties. It’s been a very helpful rotation in terms of dealing with dementia, delirium, and patients with exceedingly complex medical problems. I’m certainly looking forward to working with the geriatricians once I’m out in practice!
(Yes, CaRMS stuff coming soon. Promise.)
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