It's been a while since I've posted. Let's see. Since my last post, I have completed pediatrics, taken my Step 2 Clinical Skills licensure exam, enjoyed my half-a-week vacation, and started geriatrics. CS, Justin posted a nice description of our time in Houston. Perhaps I'll go into it later. For now, I will discuss geriatrics.
Geriatrics: The field where you have a longer time to see your patient than any other field except perhaps psychiatry. You need that time, because the patient probably has 7+ independent problems with 10+ medications, all of which likely react with each other and cause problem #8. I spent two weeks on inpatient geriatrics at UAMS. We have four students in our rotation group: 2 M3s and 2 M4s. The rotation is set up for 2 M3s. So it's been interesting. In inpatient, there weren't enough patients to go around. Some days, I had no patients. At max, I had two. Rounds weren't held until 9:30. Plenty of time to interview a patient and write a quick SOAP note.
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Fictional Geriatric Progress Note
Subjective: Pt has no complaints this am. Had one episode of diarrhea yesterday. Has requested fiber supplementation. Some difficulties sleeping yesterday secondary to overnight vitals and restless leg syndrome. Would like to be discharged.
Objective:
Vitals Tmax, Tcurrent, Heart rate, Respiratory rate, Blood pressure, Pulse ox, Total ins, Total outs.
Physical exam
Labs
Assessment/Plan: 78 y/o Asian female with h/o HTN, CAD, CHF, RLS, DM-II, MDD, osteoarthritis s/p hip replacement admitted for CHF exacerbation
1. CHF: CXR with patchy infiltrate. 2+ pitting edema in lower extremities. Increase lasix to 40mg qd. Cardiac enzymes wnl, EKG unchanged from last. Will continue to monitor.
2. CAD: No problems currently. Continue baby aspirin.
3. HTN: Blood pressures well controlled. Continue current regimen.
4. RLS: Have decreased Sinemet to 100/25 qhs. Will add neurontin PRN for better control.
5. DM-II: Blood sugars running in 90s-130s. Continue current regimen.
6. MDD: Continue celexa.
7. OA: No problems currently. Continue tylenol PRN.
8. Continue diabetic diet. DVT precautions. Incentive spirometry.
9. D/w patient and attending. Will continue to monitor.
I am currently in outpatient geriatrics at the North Little Rock VA Hospital. I see somewhere between 2-4 patients in the morning, and comparable numbers in the afternoon. I am currently sharing patients with my fellow M4. As there are usually two patients on this service. Our note is slightly different. I know you don't really care, so I won't elaborate, lol. But I love the VA computer system. Makes everything so convenient.
I am currently waiting on my patient, actually. Maybe I should go check again and see if he has arrived.
Later I will go into my Hospice and nursing home afternoons.
3 comments:
Who'd have thought older people require more time with doctors, haha did you hear that Chris Killingsworth broke his foot?
Sounds like a lot of time to do some good personal doctorin'. Glad your rotation gave you some time to post :)
So Kerry dear, the girl I'm dating down here is into Buffy and she told me there is a comic book series that takes where the show left off at season 7 and has a whole season 8. So if your interested now you know.
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