My final clinical rotation was at Gouverneur Nursing Home, where I had the opportunity to focus exclusively on geriatrics, a population I had not previously encountered in such depth. This rotation was a significant departure from my prior experiences, as I had never solely worked with older adults and had to quickly adapt to their unique needs and care strategies. It was an eye-opening experience that helped me understand the importance of holistic care, especially in a setting where the focus often shifts toward comfort and quality of life.
One of the most memorable experiences during this rotation was working with a patient, a man with lung cancer on palliative care. I first met him during a monthly visit where he shared his sadness about approaching death. He expressed feelings of fear and sorrow about what was coming. I was tasked with listening to his concerns and providing comfort during a difficult time. Over the next few days, I made it a point to visit him regularly and check in, which allowed me to build a rapport and offer emotional support. This experience taught me a great deal about the importance of compassionate communication and how it plays a vital role in patient care, especially in palliative settings.
A new treatment strategy that I encountered during this rotation was the concept of deprescribing. I learned that, in geriatrics, treatment is often tailored to minimize harm rather than aggressively managing chronic conditions like diabetes. For elderly patients, particularly those with advanced age or terminal illness, it is common to focus on managing symptoms and improving quality of life rather than pursuing curative treatments. This was a shift from what I had previously experienced in acute care settings where aggressive treatment plans are often the norm.
One of the key takeaways from my preceptor was the idea of preventing nursing home residents from requiring ED visits. As someone interested in emergency medicine, I found it particularly valuable to understand the steps nursing homes take to avoid emergency department visits. The knowledge gained about the types of care provided to nursing home patients has great relevance to my future career in emergency medicine. When patients from nursing homes do end up in the ED, it is crucial to recognize that extensive efforts have already been made to manage their conditions, and a higher level of care is needed. This will be a helpful perspective when treating geriatric patients in an emergency setting, allowing me to better appreciate the challenges they face and the complexity of their care.
Reflecting on my own growth during this rotation, I realized that I sometimes struggle to slow down, especially when managing patients with extensive medical histories or limited functional capabilities. However, I learned that with these patients, it is essential to take my time and perform thorough assessments. I found myself relying on the support of nurses and PCAs to help with complete physical exams, and I recognized the value of collaborative care in providing the best possible patient outcomes. This experience taught me to be more mindful and deliberate in my approach, particularly when I feel rushed or overwhelmed.
In conclusion, my rotation at Gouverneur Nursing Home was an invaluable experience, and I’m grateful for the opportunity to end my clinical training here. The skills and insights I gained in geriatrics will undoubtedly influence how I practice as a PA-C in the future, particularly in emergency medicine. Understanding the unique needs of older patients and the approaches to prevent ED visits will help me provide better care in both acute and long-term settings. As I move forward in my career, I plan to continue refining my physical exam skills and work on my ability to slow down and approach patient care with the attention and empathy it requires.
