Clerkship Updates: Geriatrics

I cannot believe 2019 is almost at an end! This year has just flown by! I just had an incredible rotation in Geriatrics. It consisted of 2 weeks on consults and 2 weeks managing patients on the Geriatrics wards or off-service units. There were also two 1/2 weekends on consults.

Geriatrics was challenging in many ways:

  1. Patients often have complex medical histories
  2. Patients often have varying degrees of neurocognitive disorder (dementia)
  3. Patients are often frail and at risk of falls
  4. Patients may have delirium which can be difficult to tease apart from possible underlying neurocognitive disorder
  5. Patients are dealing with many challenges such as incontinence which can be demoralizing for them. For some patients, continence may be their last act of independent functioning.
  6. Patients are often on multiple medications (polypharmacy) whose side effects can put patients at further risk of falls or delirium.
  7. Patients are faced with what we often write in the charts as “disposition”. Where will they be going next after being discharged from hospital? They are often too frail or dependent to go back home therefore may be facing the reality of moving to a residence or nursing home. There can be complex family dynamics as the details of this transition is worked out.

Despite the complexity of geriatrics, I found this to be a truly rewarding rotation as I developed close bonds with my patients and got to know some of them very well. I was really touched by some of the conversations I had with my patients and how much I learned from them. I worked with a fantastic interdisciplinary team and found the geriatric physicians to be extremely compassionate. I also developed clinical skills that will be very useful in my future practice as a family doctor.

I am now on my last rotation of clerkship! It is an elective in Allergy and Immunology and has been an extremely fascinating rotation so far! More details to come!

Featured image courtesy of Emory University School of Medicine

Published by Potential Doctor

Welcome to my blog! I'm a married mother-of-two who is journeying through medical school. I share my life experiences and interests on this blog including my hobbies, recipes, fitness, faith, music and more! I also share my experiences in medical school and my attempts at balancing this with raising a family. It's a challenge but it can be done! Whatever you hope to achieve in this life, do not let circumstances or age stop you. There may be delays and disappointments along the way, but with time you will get there!

4 thoughts on “Clerkship Updates: Geriatrics

  1. Hi Malaika;
    Just one more rotation!
    Good for you!
    A little bit of trivia for you; One in five of geriatric patients now faces these end of life challenges ALONE! So sad.
    Merry Christmas to you and your family.
    Hope you have a wonderful holiday break, and I will pray that God shepherds you through next year’s challenges as well as 2019’s:)

    Catherine Wilson

    Liked by 1 person

    1. Thank you for the kind wishes Catherine. I wish you a wonderful Christmas too. Thank you also for sharing that statistic. Very sad indeed. The rotation in Geriatrics was definitely eye-opening for me in many ways.
      God bless you and all the best for 2020.

      Like

  2. Wonderful post as always. One word of caution though, be objective rather than using words such as “frail” because one person’s “frail” is another person’s baseline. Older people are the most diverse group that we will treat; we must be as objectively descriptive as possible because it becomes easy to dismiss this population with words such as “frail”. We don’t use “frail” when we functionally describe most 30-year-old patients yet I see it on the charts of those over 65 frequently. All patients need to learn to deal with end of life challenges as soon as possible without regard to age. I have made peace with death as it is a part of life but I have end of life discussions with all of my patients. We all need to be reminded that those who have lived on this earth longer do not need to be treated much differently from those who have not. People are complex which makes medicine exciting for me.

    Liked by 1 person

    1. Thank you as always for sharing your experiences and insight. It is so helpful! Your point about “frail” is well taken. In Geriatrics, I had understood “frail” as referring to objective frailty indices that gives us an idea of overall health and level of functioning. However, I can see how the word “frail” alone without any context or description could be misunderstood or misinterpreted. I also fully agree with your point about end of life discussions. Overall, Geriatric patients deserve our attentive care just as much as any other patient and we must be vigilant for signs of neglect/elder abuse.

      Like

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