This past month I rotated in Long Term Care. Although the site I was originally assigned to got canceled due to the Covid pandemic, I ended up doing my rotation at NYPQ hospital on the Internal Medicine service. Because my rotation was still LTC, I mostly saw patients who were elderly (over age 65) or presented with complaints and conditions that the geriatric population more commonly suffers with. For instance, although a lot of the cases I dealt with included elderly patients with pneumonia, COPD exacerbation, heart failure, and stroke, I did have one patient who was only 62 years old but with Parkinsonism who very likely has Lewy Body dementia. With each of these patients I got to learn how and practice doing a complete geriatric exam, including an assessment of the patients’ ADL and IADL capability. 

One thing I loved about the rotation was that each week I was assigned to a different floor (not all were Medicine floors) and a different PA that I worked with and learned from. For instance, the first week I was assigned to a regular Medicine floor and switched off working with two different PAs, where I got to observe the different techniques and styles for rounding on patients and performing procedures. The second week I was assigned to a different PA in ETAP (Early Treatment of Admitted Patients), and got to examine patients while they were early on in the course of their illness. The great thing about that was that these patients, although technically were already admitted to the Internal Medicine service, were still being treated in a section of the ED because they hadn’t yet gotten a bed on the floor. These patients were a lot sicker, unfortunately, and required more procedures to be done urgently than those on the Medicine floor. During this week, I got to practice doing ABGs (4 times!), drawing blood, removing sutures, and evaluating patients with altered mental status. The third week I was back on the Medicine floor, again with a different provider, and the fourth week I got to work on the Stroke Team, which I loved. Each day while I was there, there was a different Internal Medicine PA who was assigned to Stroke, and each of them were amazing to learn from. I also learned how to properly perform/score an NIH Stroke Scale by becoming certified online, and then practicing my skills in person with patients. I then also got to be part of the process after the patient is initially examined by Stroke and the attending Neurologist, while they are brought to CT and decisions are made from there. The benefit of being with different PAs and on different floors is that I got to see the different ways providers approach patients, the different tricks they came up with for performing difficult procedures, and the different note-taking styles they have. 

Overall, this was a great way to learn about the different inpatient aspects that go into long term care and into treating the geriatric patient. Geriatric patients tend to have issues that are multifactorial, and doing a complete and extensive history and physical exam is really important. I think this is something I definitely need more practice with, especially since my last rotation (Surgery) had me practicing doing more focused exams with patients who generally had only one-two complaints. I also realized I need to practice speaking to patients about end-of-life / hospice / palliative care, which is something that is extremely difficult. With that being said, I do believe that all the skills I picked up will definitely be necessary and beneficial throughout many different specialties, since eldelry patients do make up the largest portion of patient volume.