Lisa Maclean: Seeing Overlaps BACK

Published by AFAR

Last night, I was trying to decide what I should look over before my geriatrics rotation. I made a list of the common medical conditions that I associate with older patients: dementia, arthritis, broken hips, cancer, heart disease. As I looked at this list, I immediately realized that there was no obvious section of my old study guides, class notes, or textbooks that would cover most of these topics. We were introduced to some of the basic principles of cancer in our biochemistry class, broken hips came up in anatomy, we learned a little about arthritis during our radiology unit, and heart disease was a major topic of physiology. Dementia had been a major topic of conversation in our social medicine class, and we’d also discussed it some in our clinical skills class, but we had learned very little about it in our basic science curriculum. My first-year medical school education had introduced me to each of the conditions on my (very subjective) list of common geriatric problems, but none of these topics overlapped in any of my courses.

Like most medical students, I’ve had fairly little clinical exposure. I’ve volunteered in the student-run clinic, and I’ve shadowed doctors in a few specialties. I’ve also had the chance to see patients in an outpatient setting thanks to clinical skills weeks integrated into the first-year curriculum at UNC. But until today, all of my experiences were confined – quite literally – to a fairly small geographic setting. I had always thought that doctors either work in an outpatient clinic or in a hospital, but not in both. Once again, geriatrics is a field where all of these seemingly discrete aspects of medicine overlap. The geriatrician that I worked with today sees patients in three settings. He spends the first part of his morning at an outpatient clinic on the campus of a local retirement community where he sees patients for routine check-ups, follow-up visits, and for treatment of acute illness. After he finishes up with his outpatient visits, he goes to the assisted living floors of the retirement community where he visits with patients who skilled nursing care, either temporarily or permanently. On the skilled nursing floor, his patients that have the same range of illnesses as many of the patients in his outpatient clinic, but their conditions may be more severe or complicated by other health problems. In the afternoon, he leaves the retirement community to visit patients in the hospital. Inpatients may be receiving palliative care, recovering from surgery, or suffering from a severe acute illness.

As I spoke with my preceptor about the variety of clinical settings that he works in, he mentioned that one of the most important aspects of his job is deciding when to transition patients between these settings. Each setting has different advantages and different drawbacks, and you often have to trade a person’s independence and social support for increased medical care. These decisions are complicated further by the patient’s financial status and insurance plan, the involvement of the patient’s family, and the resources that the hospital or skilled nursing floors have available.

During my first day of clinical rotations in geriatrics, I saw patients with all of the conditions that I had thought of last night above and (not surprisingly) I saw a number of conditions that hadn’t made it on to my list. Geriatrics draws on knowledge from every class that I’ve taken in my first year of medical school, and it also exposes me to a wide range of clinical settings. I feel so lucky to be getting this kind of clinical exposure geriatrics so early on in my medical school experience, and I can’t wait to continue.

Lisa MacLean
University of North Carolina School of Medcine 
 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.