Geriatrics 

• This rotation takes place at North Broward Hospital and the preceptor is Dr. Paolini.

This is one of your more easy going rotations but at the same time you can learn a great deal if you choose to. There is a lot of exposure to problems that are not only associated with the elderly. It can be a good setting to learn about common illnesses such as diabetes, hypertension, stroke and coronary artery disease. There is also much to learn about conditions which are common in the geriatric population; Alzheimer's, incontinence, pressure sores, etc. The schedule is far from demanding and you will have ample time to get your work done. 

This rotation has six students and depending on the month you may also have a resident from Palmetto hospital as well. Most days you will begin around 8:30 in the physician's lounge on the first floor. If there are any hospital patients you will discuss their problems and progress. There will be very few (if any) hospital patients. Most will come from the nursing home across the street. This is where you will spend the majority of your time. You will be assigned to approximately 6-8 patients in this nursing home. You are responsible for writing a complete H&P on each patient by the end of the rotation. In addition you are responsible for following them through any acute problems and writing progress notes for these problems. You are allowed (and expected) to write directly in their charts and to write orders as well. All of your orders and notes will need to be co-signed by Dr. Paolini and/or the resident. 

When you are first assigned to your patients it is important to introduce yourself to all of them and read their charts before assessing them. You will find that you have a patient (or 2 or 3) that can't communicate with you for one reason or another (i.e. aphasia from stroke, neurological disorders like ALS, or they may just not speak English). Perhaps the best source for quick reference on your patient is the student H&P from the previous month. Be careful not to copy their H&P for your own...just use it to get an idea of what's going on before you assess your patient for the first time. Also, when getting a list of meds for your patient make sure that you look in the MAR on the medicine cart...not in the chart! The med list in the chart isn't as current as it is in the MAR. 

Things move pretty slow in the nursing home...including getting labs back. If you are expecting a lab and don't see it in the chart try looking in the nursing office where the lab printer is located. The care in this facility is not optimal and you may find things that are sometimes upsetting to you. Just be glad that it's not your relative and go on with your day. Let's face it, few of us are going to love geriatrics but it is an important rotation because of the common illnesses you will see as well as the advancing age of the U.S. population. 

Eventually you may have a hospital patient. If this happens you will be responsible for rounding on this patient before your morning meeting and have all the up to date information ready to present to the group. Review your SOAP format and make sure that you know what goes where. Do not interpret results in your objective section. If a lab value is high or low just simply put the number in your objective and interpret it in your assessment if necessary. Dr. Paolini is big on being able to interpret the results on your own. Also don't forget to list ALL problems in your assessment. Most people forget to include things like depression and immobility (or just decreased mobility) in their assessment and these issues are very important to include. Remember that Dr. Paolini is very into problem based learning so while asking intelligent questions is important, it's also important to do your own research to figure some things out. If you have a question that may seem elementary (i.e. What are rales again?) it is better to look it up yourself or ask your resident. Please remember that on this rotation your resident (if you have one) will be evaluating you equally with Dr. Paolini. In fact, you will probably spend more time with the resident than you will with Dr. Paolini so guide yourself accordingly. 

You will also have to sit through lectures on end of life care with Kate Callahan,R.N.. By the end of the month you will go through all but one of the modules to become EPEC (Education for Physicians on End of Life Care) certified. You will also be required to do a review and presentation of a recent (last few months) journal article as well as a case presentation of one of your patients. It is recommended that in addition to your case presentation that you identify some learning issues from your case and explore them further. 

Each student will go to a clinic with Dr. Paolini at least once. These clinics include the NSU clinic in Davie, the Geriatrics Institute and the John Knox Village. Be aggressive in these clinics and make sure you know how to do a good focused (and for new patients, a complete) H&P. At the Geriatrics Institute most of your patients will also have psychiatric disorders so you might want to review some of your more common psych illnesses and drugs. 

There will be many times when you will be "on your own" on this rotation. Dr. Paolini will frequently have to be at NSU for meetings, classes, etc. It is up to you to see your patients and get your work done. There will be days when you won't have to go in until late or days when you can go home early. Just make sure you have your work done. The best advice is to work your butt off in the first week or two and finish all of your H&P's and then just sit back for the rest of the rotation. It goes without saying that you should be on time for everything, appear interested, ask questions and participate in discussions. 

There is home call on this rotation but you will rarely have to come in. There is only one pager and it must be handed off to the next student on call every morning. If you have your own pager you may use it for your call. If you are on call over the weekend you will probably have to come in at 8:30am only if there is a hospital patient. If there is an admission in the middle of the night you will only be called if it is an interesting or complex case (i.e. one she can't admit over the phone).  You are encouraged to make a phone list and give it to your fellow students because there is an occasional schedule change at the last minute. You should also take your ID Badge (if you have a Broward General ID) to the security office and they will code it so you can gain access to the physicians lounge. If you are from Palmetto or another hospital outside the NBHD you will need to get an ID from the medical staffing office. 

Lastly, if you live in the Ft. Lauderdale area the best way to get there is probably going to be the Turnpike. If you live out west (Weston or Plantation) you may be better off taking the Sawgrass Expy ($1.50 each way). The hospital is one block east of I-95 on Sample road. Watch out for traffic when going in at the usual time, leave enough time for unforeseen conditions. Also, if you are going to be late page Dr. Paolini to let her know...she is very understanding.