Tuesday, November 11, 2008

geriatrics

2 weeks of geriatrics has ended and i must say it's been an eye opener. geriatricians are truly the best clinicians around, they manage patients holistically and genuinely seem to care for them. on top of that, their medicine knowledge by no means pales in comparison with those doing internal medicine!
some of the hardest MBBS examiners around are also geriatricians. hmmm.

i've learnt about polypharmacy (so common!!!!), falls, incontinence, dementia etc. and it's startling to know just how many of these we attribute to "aging" and write off as being normal when they could be treated!

and another scary thing is how fast my parents are heading into the geriatrics age bracket (alright it's a good few years but still), they're no longer as young as i thought they were. and it's never something easy to understand, your parents growing old. somehow i always thought they'd always be there! :\ i can't imagine life without my mum and dad (i mean, even when i was overseas/staying in hostel, they're still there.)
but all things must come to pass. i just hope i don't get there too soon!

seeing all the elderly folk every morning on rounds makes me sad. most of them have social issues and no caregivers, and the wait for nursing home places is miles long. as a result, the doctors are frantically trying to get them out of hospital to make way for more acute patients, and it seems that no one wants them. must feel terrible, to be so old and to have lived so long and done so much (i'm assuming) and to be so unwanted in the end.

geriatrics breaks my heart, and it reminds me too much of my gram. but i do think that it's an incredibly worthwhile specialty to go into if you're looking for all-rounded care of patients.

we were scolded really badly on rounds, for our gross lack of knowledge and finals being only 4 months away. basic interpretation of ECGs, BP taking (i didn't know that you can't take BP from a hemiplegic side!), feeling of cervical lymph nodes, my groupmates and i have failed miserably.
it's a call to wake up and start studying, we obviously didn't know as much as we thought we did. but at least there's 4 months to go which hopefully should be enough time!

now we're into the final stretch, 14 weeks to go to finals. 6 weeks of medicine and 4 weeks of surgery, with 4 other weeks in between on minor postings. it's the home stretch, so wish me luck!

4 comments:

Dragonfly said...

I have much respect for geriatricians - the polypharmacy, the social issues, the end of life decisions. Rock on.....

Sue said...

Yes - Geriatricians are the last generalists in the inpatient medicine system. Their skills are nt highly rewarded because they don't have a unique procedure to bill for. However, don't forget the true generalists - the Emergency Medicine specialists. Emergency Physicians rely on clinical skills and problem-solving, and deal with presentations across the full spectrum - form kids and O&G to mental health, gastro, orthopaedics, head injury, poisoning, as well as acute geriatrics.

When you do your ED rotation, don't just try to learn procedures, use the time to learn the cognitive skills of emergency medicine - diagnostics, prioritisation, problem-solving, negotiation...

HM said...

Geriatrics sounds so unbelievably difficult, utmost respect to those docs. Not sure it's something I'd be able to do on a daily basis.

The Angry Medic said...

Hey ditzy! First off, sorry for the long absence from your blog - I was a crap time organizer in pre-clinicals and now that I'm in clinicals it's even worse.

But hey, at least not I can understand what you mean when you blog - I see so many elderly patients too, and also realise that my parents will soon be in that age bracket too. But it's like one of my 6th-years said: seeing them makes you realise how important manners and diagnostic skills are, it could be your dad or mum sitting there one day. Drives me to be a better doc to them and not just write them off as GOMERs like so mant docs do.

I've added you to my new blogroll. I'll be back!