How did it go? What have you learned? What can you improve? How do you plan to improve these new skills?

I genuinely enjoyed this rotation where the focus was on the geriatric population. Although I have been at sites where many elderly patients were seen, the approach used for patients here was unique and eye-opening. For example, using the geriatric assessment tool during visits was interesting and something I had never seen before. I was fortunate enough to be placed with mentors that were eager to teach. Interestingly, out of all the rotations I’ve gone through thus far, the knowledge that I gained through my clinical experience here helped me the most during my end of rotation exam. My understanding has been elevated on many crucial topics such as polypharmacy, medication adverse effects, dementia, anemia, and more. One thing I’d like to improve on is my ability to recognize the different types of gait and what conditions they are associated with. For example, if I see someone with a stooped posture and festinating gait, I hope to be able to identify it as such and think of a possible association to parkinsonism. I can improve on this skill by paying close attention to the way patients walk from now on, especially those that I know the diagnosis of. Over time hopefully I can improve on this skill.

 

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

As a PA, I expect to encounter the geriatric population in most of the fields I can go into. The continuous growth in the portion of people making up the 65 y/o and older population puts emphasis on our need to understand the unique needs and features of the elderly in order to provide better care. Therefore, I expect the knowledge gained from this rotation to be highly applicable to other rotations and my career after school. For example, something that the geriatric providers took note of was the mismanagement of elder patients when admitted. Often, the internists would prescribe medications on the Beer’s Criteria list, such as a those that can increase risk of dizziness and falls; this would usually happen in the case of delirium or difficulty sleeping. The geriatricians taught me that many of these medications are unnecessary and pose bigger risk than benefit. One of the biggest, and most impressive skills I realized the geriatric providers had was the ability to think “outside the box” when coming up with solutions for patients. For example, instead of prescribing Ambien to elderly patients to help them sleep while admitted, they suggested trying a warm drink before bed, reducing the frequency of staff waking the patient up during the night, and keeping windows open in order to help establish regular circadian rhythm with sunlight. In the future, I hope to be able to come up with these types of solutions for my patients instead of unnecessary pharmacotherapy with the potential of polypharmacy and adverse effects.

 

What was a memorable patient or experience that I’ll carry with me?

A memorable patient experience that I’ll carry with me is one that I presented during my site evaluation. This was a woman in her late 70s who presented to the clinic for routine follow up. One of her active problems was insomnia, for which she was taking Lunesta (despite this medication being on Beer’s Criteria list and having the recommendation of being avoided in the elderly). She reported significant improved with this medication and had no issues. The provider and I decided to ask more questions about the patient’s sleeping habits in order to think of solutions that could allow the patient to discontinue this medication due to its risk of causing dizziness and falls. After a few questions, the patient was asked about her nightly routine, to which she admitted having a cigarette and drinking a cup of regular coffee every night before bed. At that point we realized that this habit was the likely cause of this patients insomnia and gave several recommendations, including instead having coffee in the morning or switching to decaf coffee. We gave these recommendations and discussed the risk involved with taking Lunesta. The takeaway point I gathered from this experience was the importance of asking more questions when there is a complaint! If we did not ask the patient to tell us about her nightly routine, we may have not discovered that she was drinking caffeine before bed every night. In any instance, it would be very “easy” to see that the patient is complaining of insomnia, then prescribe medication to help, but the right thing to do as a provider is to ask more questions and see if there are modifiable causes to the problem.

 

What one thing would you want the preceptor or other colleagues to notice about your work in this rotation?

One thing I would have wanted my mentors on this rotation to notice about my work was my ability to make patients feel heard and seen. While patients would be discussing their complaints to me, I would devote all of my attention to them and provide nonverbal cues so that they knew I was listening to them. I think as providers we become consumed with documentation during patient interviews, so we may be looking down at our pen and paper or even be typing away at the computer while the patient is talking to us. My role as a scribe before PA school taught me the importance of actually making patients feel heard because as I was typing away and recording the important information, the doctor I worked with was able to actual look at patients during the encounter and they always expressed gratitude for this. This time on this rotation, I was able to take part in the provider role and be the one looking at patients and engaging with them in a meaningful manner. While preceptor may not have noticed this, it was gratifying enough to have the patients themselves genuinely thank me at the end of their visits.