Long-term care was a challenging rotation as the patient population was complex with multiple comorbidities. The patients I saw at the St. Albans VA facility were there for years and many needed assistance with all ADL. The most challenging part of the rotation was managing the patients’ comorbidities, deprescribing, and titrating dosages. This was something I was very happy to learn as it’s an important part of managing geriatric patients as the geriatric population is at an increased risk of polypharmacy, delirium, and falls. Learning to titrate, and deprescribe medication was new to me and I learned the importance of it as certain patients were on several different hypertensive medications. Where the patient only had elevated systolic blood pressure and diastolic stable. I learned this was attributed to patients not being cooperative in the morning when taking blood pressure measurements and would be agitated which would drive their systolic higher, and being on multiple hypertensive medications was unnecessary.
Going into Long-term care I was not aware how different writing an HPI would be for long-term residents. It was a challenge to get a full HPI from patients who were at the VA for many years, and many of the patients had dementia, and Alzheimer, and thus getting an accurate story wasn’t always possible or patients were not cooperative. However, this challenge allowed me to become better at gathering information from previous charts and speaking to medical staff to gather information. At first, I struggled with painting a picture of the patient prior to admission to St. Albans, and who they were before becoming residents at the VA, and my organization lacked a flow, but by the end of the rotation I was able to have a flow that told the whole story about the patient.
LTC allowed me to perform MMSE which I never had done before, and it allowed me to get an understanding of the patient’s cognitive function which is quite important to know if the patient is a reliable source of information.
What I’ve learned from this rotation that I will be carrying into my future rotations is how to manage multiple comorbidities, and perform MMSE. These skills will be vital for my 7th rotation in family medicine. LTC was not procedure heavy, but I did get to perform rectal exams and perform blood pressure. My next rotation is surgery, and hoping to get a lot more procedures completed.
