This rotation was very reminiscent of family medicine for me: 1) patients had many disease conditions and comorbidities; 2) there were many labs and imaging that needed routine follow up; 3) patients took a lot of medications; 4) there was a lot of learning. And also like family medicine, this rotation was entirely outpatient and operating in a 9-5 clinic, which meant that all patients presented in stable condition. However, there were a few differences that oftentimes made long term care feel entirely different from family medicine: 1) polypharmacy was extremely important, and medication reconciliation was done (or at least attempted) at every visit; 2) visits were not just focused on management of chronic disease, but also on things like “happiness” or “quality of life” or “what matters the most” to the patient; 3) there was less disease screening as many patients had aged out of screening guidelines; 4) there was more focus on physical and mental capabilities as it related to functional independence.

Managing chronic disease in patients whose own diseases and/or medications complicate their presentation and prognosis in a way that must also be reconciled with their own happiness, cognitive functioning, and relative life expectancy felt like practicing medicine with a different spin on it – similarly to how I felt in pediatrics or OB/GYN. And while I recognized the importance of managing that balance and enjoyed seeing my preceptors do so with expertise, this rotation still felt very melancholic for me. There was the occasional geriatric patient with well-controlled disease, a positive outlook, and no complaints; but more often than not, patients were dealing with life-threatening comorbidities that were burdened by declining memory or cognition, impaired mobility, and bureaucratic barriers to much-needed services like transportation and home health. This was something I really did not enjoy seeing, which is good to know as I begin my job search. 

This rotation – as my last – also gave me the chance to reflect on my growth as a student. Compared to my first (and even my second, third, and fourth) rotation, I felt more confident interpreting and deriving important information from charts that had been updated by different providers and their different styles. I felt more confident about doing focused physical exams, while also knowing when/how/in what direction to move forward should patients offer new/additional complaints. And I felt more confident about my lack of knowledge and my capacity to learn – and learn quickly – as I go.