Geri Clinic

Much of geriatrics was clinic-based, and it's the first outpatient rotation I've had in a long time. Although I tend not to like clinic (it's why I'm going into anesthesia), I still find it educational. I think I'm a fairly conservative outpatient doctor; I try very hard to avoid adding on unnecessary medications, and I spend most of my clinic visit seeing if I can peel back medications. This is especially true in geriatrics. Many of my patients took more than 10 medications - indeed, if you follow heart failure guidelines, a patient with heart failure (from coronary artery disease) ought to be on an aspirin, beta blocker, ACE inhibitor, and statin. Some are also on clopidogrel, additional anithypertensives, antiarrhythmics, and anticoagulation as well. The heart medications themselves add up to half a dozen. Then add on medications all vets are on - tamsulosin for benign prostatic hypertrophy, a couple inhalers for COPD, vitamin D and calcium - and you're well on your way to double digits. Polypharmacy is such a major problem, and probably contributes to the cost of health-care - not only the cost of the medications, but the hospitalizations when patients mix them up.

Otherwise, geriatrics clinic also focuses us on medical problems we see less commonly in the inpatient setting. I spend my time doing mini-mental status exams to characterize dementia, assessing fall risk, and thinking about health screening. There are special clinics as well for patients who are especially complicated and high-risk; they are seen by a team of social workers, psychologists, and nurses for a comprehensive approach to aging. It's a good experience for us as interns to care for older patients in the clinic setting.