One the first day of my LTC rotation we started off with a team meeting in the medical office, where we met all the providers and the chief of staff Dr. Bartholomew. He started off the session with a summary of new admissions, number of beds, scheduled appt for patients, and episode of falls for the night before. They spoke about any new concerns for current patients, change in mental status, transports between wards, recent deaths, patient’s family concerns and a few others. At some of the meetings we would have demonstrations done on devices that were being added to the wards. One such device we learned to operate was the bladder scan, which was used to r/o urinary retention. We also discussed guidelines for vaccines, treatment options in certain disease processes, and new drugs among other important topics. They then opened up the discussion to any questions from providers or students. These meeting took place every morning from 9-10 throughout my rotation, and I found them to be great part of my learning experience.

Going into my LTC rotation I had almost no experience with the geriatric population, aside from my mother in law and grandmother. At first, I was very concerned about how well prepared I was and was constantly doubting myself. I started my first day at the adult day care where I had a nice little room that was fully equipped with a computer, a patient bed, and a vital machine. Patients that had any health concern while being away from the day care was addressed in this office. My first patient was an AA male that had suffered a GI bleed and was back at the day care s/p hospitalization. My preceptor asked me to examine him and then come back to discuss what should be done next. After I performed my history and physical I returned to her and presented the patient. She then directed me to go review his chart and then formulate a plan for him.

After reviewing the chart it became evident that the patient left out a chunk of his past medical history and medication list. The patient had clearly denied any Pmhx of HTN, heart disease and cancer, which were all a part of his problem list. He also had underwent a colonoscopy at the hospital which he didn’t mention. When I tried to question him a bit more he became upset and said “well I’m better now so why does it matter”. I tried to explain why it was important and he cut me off to ask me “can I go back to my bingo game now” My preceptor stepped in and said “yes you can go back but will have to go to the appointments that are scheduled for you”.

After he left she told me not to take it personally, and explained the patients had a lot going on in his life at the time. From this experience I learned that forming a good relationship with your patient is essential in treating them. Leaving out parts of the history or becoming frustrated with the provider was something I saw very often throughout my rotation.  However, I learned that when you use a friendly approach and take the time to get to know the patient they may become more open to sharing their fears and concerns. As my rotation went on most of the day care patients warmed up to me and at times would even ask to be seen specifically by me.

After a few days I developed much more confidence and started seeing the residents at the facility for acute issues. Most of these patients were excited to see me and were very happy to be examined, while others would refuse to be seen at all. During the first few weeks of the rotation there were days where it became emotionally challenging for hear some of these patient’s stories. There were some days where I thought about the patients for hours after going home. I honestly started to think it was the saddest place for anyone to work, until I realized how much joy there really was in caring for these veterans.

My daily interaction brought me closer to each patient and made me see that they were not all miserable in their situations. There was Mr. K who loved talking to me about the news and his grandkids. Mr. R thanked me for coming in with a smile every morning and said it made his day. Mr. S. was always very thankful for the care I was proving him with, he said he wished he could keep me there forever. These little comments made me realize the important role we as providers play in the lives of these patients. We not only are their caregivers, but also become their friend and advocate. I learned that just because they are ill or in the hospital for long term care doesn’t mean they can’t still be happy. The VA provided entertainment and special events for the veterans periodically, and most of the staff there really cared about the patients. It was actually a great place to work and was very rewarding.

Some other clinics I was able to spend time at included the vascular clinic, urology clinic, and phlebotomy clinic.  At vascular I was able to learn about vascular and arterial disease and ulcers management. I learned to apply an unna boot, change dressing, collect a wound culture, and debride a wound. During my time at the urology clinic I was very fortunate to shadow Dr. Jefferey Weiss a great urologist and Department chair at Suny Downstate Medical center. I was able to learn so much from him about how to approach, manage and treat patients with prostate cancer. Additionally, during my time in the urology clinic I saw my first case of a bilateral inguinal hernia.  Some other things I picked up were how to perform genital exam, prostate exams, and a catheter change. Finally, the phlebotomy clinic had the best nurses, who were eager to teach us how to draw blood. I personally have a lot of experience with blood draws and injections, but I would never miss a chance to practice my skills.

Overall this was a great rotation and I gained a lot of experience, but there are some things that I would still like to improve on. For one I would like to become more confident in prescribing medication to patients with multiple comorbidities, which requires knowing the medications side effects and interactions well.  I plan on studying some of the more common medications that I encountered during this rotation and will do the same with all future rotations. Another thing I want to work on is being able to control my own emotions during patient encounters and learn shift my focus to the patient needs and treatment. I have been working on this and see an improvement but would like to continue to make myself stronger in this area.

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.