For my sixth rotation, I had the pleasure of working at the St. Albans Veterans Affairs for Long Term Care. This rotation was definitely different from most of the rotations I have completed. Although I have encountered elderly patients before in other rotations, such as Internal Medicine and Emergency Medicine, this experience was distinct because we were seeing these patients on a long-term basis and exams were more comprehensive rather than focused on the acute issues. With that being said, I learned a lot about geriatrics on this rotation.

One thing I learned on this rotation is how to approach taking a history and physical exam with patients with multiple chronic conditions who may not be verbal. Most of the patients I encountered had dysarthria or simply were non-verbal which made it difficult for me to take a good history from the patient. One way I overcame this issue was to look at other cues, such as noting whether the patient would grimace, raise their eyebrows, nod their head for “yes” or shake their head for “no” when asking the patient questions. I would also communicate with the nurses on staff to inquire about any new updates or changes to the patient’s status. Another thing I would do is look at the nursing notes or notes from other providers or services to gather all the information I needed. In the future, this would be good practice to continue as I go through the rest of my clinical year, as patient will not always be reliable sources; sometimes collateral information must be obtained. 

Another thing I learned during this rotation is how to write monthly notes for patients. Writing notes for the patients, or “residents,” is very different from writing notes for those being seen outpatient. Most of the patients I saw during this rotation had been living there for 10 or more years and had an extensive medical history; therefore, writing up notes for these patients were more comprehensive as opposed to the focused H&Ps I’m accustomed to writing. There was a lot of research I had to compile to write a comprehensive H&P. I also had to write an assessment to address each one of the medical conditions the patient had along with the plan to move forward. Having the ability to compose a well-written, comprehensive note that another anyone can follow without leaving out pertinent information is a skill that will be carried out throughout the rest of clinical year. I believe that I will have the opportunity to continue practicing more comprehensive H&Ps during my family medicine rotation. I hope to be as diligent in my search to obtain any bit of history I can get on the patient to write a well-written note.

On this rotation, I also had the opportunity to shadow and help in the vascular clinic. In the vascular clinic I was taught how to place an Unna Boot. The NP that day went through the basics about venous versus arterial ulcers and how to approach management for each. She also allowed me to actually remove an old Unna Boot, clean the wounds and remove any debris, and place the new Unna Boot. I was appreciative of the fact that I was able to learn this new skill because my next rotation is surgery, and I have been made aware that there is also a vascular clinical where I may have the opportunity to do this again. I will use the knowledge and tips given to provide proper wound care and place an Unna Boot. 

Overall, this rotation has taught me the importance of patience. It has also shown me how essential it is to show these types of patients that you care through that same patience. A lot of these residents didn’t have family members who came to visit and coming by to say or to see if they needed anything meant a lot to them. Sometimes there were things I knew I had no control over, but I at least gave the patient reassurance that I would try and see who I could get in contact with to get them what they needed. Patience is needed with all patients, but especially with this specific population and I know that this experience will be a constant reminder about the need to be patient and compassionate with every patient I encounter.