Types of patients you found challenging in this rotation and what you learned about dealing with them?

The biggest challenging in this rotation is that all the residents here are geriatric patients. The most important thing is to learn how to communicate with them more effectively, since most of them have delayed understand and response.  Therefore, usually I have to spend more time to explaining the information. I order to communication with them effectively, I will try to stick to one topic at a time. For example, the most common topics I used to educate my patients are including drink more water, fall prevention, and pain management during the education section of the monthly check up. But overload of information can confuse patients. Therefore, I only picked one topic for education each time. And I also simplified instructions and wrote the instructions in a list on a paper. And I made an approximation of his visual acuity by observing him read the small newspaper.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

My perspective about the elderly patients has changed as a result of this LTC rotation. Firstly, I realized that the communication with elderly patients was different with other younger adult patients. To communicated effective with elderly, I have to spend more time to listen to their concerns and talk with them to build a trustworthy relation. And when I interviewing the elderly patient, I have to speak loudly, slowly, and clearly due to most of them may have hearing loss.  And I noticed that sit face to face is important when talk with the elderly patient. It will provide them with undivided attention. For physical examination, the process may also different during the elderly patients. For example, I was required to exam a patient’s visual acuity for his monthly physical check up. However, he refused to read the Snellen chart. Then I saw a newspaper on his bedside table, so I asked him how about read any paragraph which he interested from the newspaper for me, and he was so glad to do that and share his concerns with me about that newspaper.

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

As we know, the world’s older population continues to grow at an unprecedented rate. Today, 8.5 percent of people worldwide are aged 65 and over. The geriatric patients are not only seen in long term care, but also in all other rotation site, such as internal medicine, psychiatry, as well as emergency medicine. The first knowledge I’ve gained here is to review and verify the elderly patient’s medication. Since they usually have a long medication list, I have to pay attention to the drug to drug interactions, and also if those medication affect patient’s liver or kidney functions, especially those patient who already has liver or kidney diseases. For example, many elderly with severe cirrhosis and/or associated renal insufficiency, I have to be careful about prescribing Metronidazole, and reducing dose by 50% is recommended. In addition, maintain safety and fall prevention is another important thing I’ve gained here. It is important to assess fall in elderly since it happens frequently and also may lead to serious consequences, like unconscious, brain bleed due to hit the head or lost control of bowel or bladder. Therefore, the knowledge I’ve gained here can be applicable in other rotations.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

For the following rotations, I would like to continue to practice my procedure skills by following the log book. There are still a lot of other clinical skills that I would like to practice. Therefore, at the beginning of each following rotation, I will let my preceptor know that I am interested in practicing my clinical skills and ask if they are willing to teach me when there is a chance. And the second thing I want to improve is how to describe and identify the skin lesion. Because I have a hard time to tell an abnormal growth or appearance compared to the skin around it, especially in patient who has dark skin color. Therefore, my action plan is to review dermatology slides from the academic year, watch more derm physical examination videos and lesion pictures, and also online write up examples.