Rotation Reflection:
My first rotation was LTC at the VA by St. Albans. Just like everyone else, I was really nervous on my first day but at the same also excited to leave the classroom and see “real” patients. All the patients at the VA were veterans, mostly from the Korean and Vietnam war and I’d say about 70% of them were diagnosed with some type of dementia. Some of these residents also suffered from PTSD and schizophrenia and these types of residents were very hard to treat and deal with them. Mainly it was because they were unpredictable and could become violent at any moment. The nurses and my preceptor always warned me to always be careful around them when performing a physical exam and stay on high alert. One way I learned how to deal with these kinds of residents was by making sure I was not agitating them or causing any pain during my physical examinations. For example, if they were watching TV and I needed to perform a physical exam, I would not turn off the TV or bother them at all, just continue with the physical exam and always look for facial expression for any signs of distress.
One memorable experience during my time at the VA was when I had to replace a Foley catheter with a new one. My preceptor asked if I wanted to give it a try and I didn’t want to miss out on the opportunity and went for it. I was very nervous and didn’t want to cause pain to my patient. I took my time and tried to remain calm and with a little assistance from my preceptor I was able to successfully replace the foley. The hardest part was when I reached the prostate. The resident had BPH so when I got to that point, I asked the resident to cough and while he did that, I pushed the foley forward and inside the bladder. While I was inserting the foley, I realized how different it is when you practice on a dummy vs when you insert it on a real patient.
Another challenge that I experienced during my rotation at LTC-VA, especially the first week was coming up with assessment and plan for each resident that I saw. During our didactic year, we were exposed to multiple diseases and disorders and how to identify them and distinguish them from each other, however when it came to treatment and management, especially for geriatric population, we weren’t exposed as much. To overcome this, I started using “UPTODATE” and also my PPP book to learn which treatment would work best for an elderly person while considering their comorbidities as well. For future rotations, this is definitely something that I want to improve and the best way to do so is by more exposure and more studying and reviewing.
Another element that I really liked during my rotation at LTC-VA were the notes. My preceptor allowed me to see residents by myself and for each one of them I had to write a focused SOAP note. My preceptor would always check my notes and make recommendations for future ones, and by the end of this rotation I felt much more confident when writing notes on the computer system. I was also exposed to monthly notes, and full H&Ps which I’m very thankful for because being able to write good notes can be useful for the rest of my rotations. Each day I’d write about 5-6 SOAP notes and during the 5 weeks that I was there, I wrote about 17-20 monthly notes and 4-5 full H&P’s. Going forward, I hope I get to write more notes but at the same time I also like to be exposed to more clinical procedures and be more hands on.
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