For the first LTC site evaluation I had a constant fear of not meeting my evaluators expectation. On the morning of the evaluation I was very nervous, but as soon as she (Dr. Davidson) walked into the building my nerves calm down and I became more relaxed. I didn’t know how nice it would feel to see a familiar face at the VA. We chatted a bit about her commute and my experience at the VA and then went on with my presentation.
The patient I chose was a 76 y/o resident at the VA. His PMHx consisted obstructive sleep disorder, COPD, HTN, avascular necrosis, depression and HDL. He was seen at bedside for f/u of cough and H/A without SOB and fever x 3 days. The patient was diagnosed with the corona-virus, supportive care was initiated, and he was put on droplet precaution.
After I presented the patient Dr. Davidson pointed out that I spoke a bit fast and left out some important points about the patient’s past medical history. I failed to mention how long each of the patient’s medical condition existed, and if it was well managed at the time. At my last rotation the patients usually had very few comorbidities, and presented with only one complaint or issue. The approach to LTC patients is very different, since most present with multiple medical problems that have to be continuously managed at each encounter. In urgent care we would address the one complaint that they presented with and for the other issues they were advised to follow up with their PCP. In long term care you are their advocate and need to be aware of any change in their health status. This way you can make the required adjustment In care and arrange for them to be seen by a specialist when needed. She also explained the importance of exploring the patients home situations in case of future discharge, this was once again not something that I thought of before the evaluation. Further, we spoke about understanding what would matter most to a patient in LTC in terms of life, function, and happiness.
Next, we went over my procedure log and I explained the trouble I had been having with being able to perform most procedures. She gave me advice on how to be proactive and provided me with the contact info of a former student that could help me develop a network. We ended the session after I presented the pharm cards and discussed some of the other patient encounters I had had so far. Over all the first evaluation went very well, I was glad to have received feedback and was determined to improve my approach of providing care to LTC patients.
During the second evaluation at the VA I was more confident about my presentation. This was mostly because I had spent almost 4 weeks at the VA and became more comfortable in eliciting a history and physical. For this evaluation I did an H& P on a patient that presented to the urology outpatient clinic. This was a 67 y/o AA male, 30 pack year former smoker (quit 15 years ago) w/ a PMHx of obstructive sleep disorder, HTN, GERD, erectile dysfunction, HLD, prostate cancer s/p radiation c/o of frequent night time urination x 1 month.
After presenting the patient my evaluator pointed out that I was well organized and gave a good presentation, which made me feel very accomplished. We went on to discuss the article I chose to base my plan off of, and had a discussion on the different things that can cause or have an effect on nocturia. We also spoke a bit about my experience at the VA in terms of patient care, procedures, and access to other clinics. At the end of the evaluation I realized how important her feedback from our first session was and could see how it had helped with my improvement. I still have to brush up on parts of my H&P, and feel with more practice my skill of writing an H&P will become stronger. I am very grateful to Dr. Davidson for her dedication, support and guidance in our journey of becoming more competent Pas.
Self reflection:
I went into LTC having almost no experience with the geriatric population, aside from my mother in law and grandmother, and I felt it would be a very challenging rotation. I noticed the more time I spent at the VA the easier my patient encounters became. I came to know the patients and became more familiar with some of the more common illnesses shared among the residents. able to spend a day in the urology clinic, where I met a patient who came in
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