After Nutrition Outpatient Counseling, my next rotation was Geriatrics. Well, officially, it’s called “Geriatrics” but it’s really a combination of LTC, rehab, and hospice/palliative care. “Geriatrics” isn’t really the most accurate of names because you get patients of all ages. Some people are there to learn to use a new limb. Some people are there to adjust to being on tube feeds. Some people are there to peacefully live out the end. Some, but not all, will require specialized health care. The only similarity between all the patients are that they’re expected to be there for a while.
Geriatrics can inevitably be hard on some interns, because while death is something you deal with in all the clinical rotations, it’s more or less a fact in this rotation. Oh, I’m not saying that someone WILL die during tbhe two week rotation. No, death is just more real and present on everyone’s mind, because some people are there to just pass quietly away. Discussions about advance directives and finding out what the family wants are the norm. Which completely changes how you approach nutrition with the patients. If the doctors say a patient only has a couple of days to live, I’m not going to go in and counsel the patient on sodium reduction. It’s just not appropriate. If a patient is there for rehab after having an amputation due to uncontrolled diabetes, then, yeah, it’s appropriate for me to go in and counsel on managing carbohydrate intake. As with all the rotations, you have to decide what the best course of action is on a case by case basis.
This rotation was also full of meetings. Of course, there’s daily rounds to see if there’s anything that’s changed overnight. Also, in LTC, you have to have care plans where each service details what they expect and plan to do and you have to review the care plans on a regular basis. So I ended up spending a ton of time in meetings. It was interesting to hear what progress markers the other providers were looking for. (For example, PT might make it a goal that the patient could walk up four steps of stairs using a handrail one week, then raise it to five steps the next.) It’s definitely a huge team effort.
One thing that is different in Geriatrics compared to all the other rotations is that since it is technically the LTC rotation, you’re supposed to refer to the patients as “resident” (or “Veteran” in the case of the VA) in your notes. Never as “patient.” (I’ve been using “patient” in this blog post because this is a blog post and not a chart note.) Some tips for the Geriatrics rotation:
- Review tubefeeding. There tends to be a lot of TF patients in this rotation.
- Sometimes all you can do is encourage the patient to eat.
- Be sure to talk loudly and clearly – a lot of the patients are hard of hearing.