Geriatrics

At the mid-way point of residency, I'm on my geriatrics rotation. Geriatrics is a required rotation for all interns per ACGME recommendations, and it is the lightest of our rotations. As the patient population ages, understanding issues faced by geriatric patients becomes more and more important. And equally importantly, interns need a good outpatient rotation to break up the monotony of wards.

One of the main activities for this rotation is skilled nursing facility (SNF) rounds. We often discharge our patients to SNFs for rehabilitation or hospice. These patients have nursing requirements, but don't need to be in an acute care hospital. But I never thought of what happens when patients go there. Making rounds on SNF patients is really enlightening as it allows us as interns see what issues arise for patients after leaving the hospital. We see the long road to recovery, we begin to understand the physical, emotional, mental, and psychological issues of transitioning to independence. Oddly enough, we get a flavor of how insurance companies and Medicare fit into the scheme of approving or denying care. We get a really important sense of how discharge summaries for SNFs differ from those for patients going straight home; the SNF physician needs to know what rehabilitation or skilled nursing needs a patient has. For those reasons, even though it's not a high yield rotation in terms of learning medical knowledge, it's essential to understanding how the medical system as a whole operates. We also take home call for the SNF to be available for questions or concerns. The issues that come up are similar to cross-cover but require us to understand how to triage complaints over the phone.