Long Term Care was a great rotation, where I got to see a completely different area of medicine that I had previously seen. It was my first inpatient rotation as prior to this I have done pediatrics, emergency medicine and ambulatory medicine. I did my rotation with an internal medicine team at one of the hospitals in Queens. In order to make this an experience with geriatrics, I was assigned the geriatric patients who were admitted to the team. 

I saw a wide variety of cases including sickle cell crisis, Covid-19 pneumonia, failure to thrive, sepsis, tachycardia, GI bleeds, pulmonary embolism, DVT, esophageal malignancy, falls, hypertensive emergencies, decubitus ulcers, vertebral compression fractures, alcohol withdrawal, drug overdose, atrial fibrillation, altered mental status, and hydronephrosis. The wide variety of cases I saw here contributed to my learning in a big way, each case was discussed in great detail during rounds each morning with the team. Several disease states I saw more than once, and having seen them prior I was able to contribute to the discussion on treatment the next time. Each day after I arrived, I would print the list of the patients on my team, choose a new patient to see, with an emphasis on choosing the geriatric patients. I would then review their chart, make sure I was aware of any new labs, imaging and vitals. After I would see the patient, confirm the history with them and perform a physical exam. By then rounds were beginning, and when it was my turn to present, I presented the case to the attending, with history, physical, assessment and plan. 

In the beginning of the rotation I had to adjust to having the information for the patient in front of me before I went to see them. Having someone else’s notes was valuable but also had some disadvantages. It was difficult in the beginning for me to come up with a plan for the patient myself when it was already written by whomever admitted the patient from the ED. However, as time went on and I got more comfortable with the process in the morning, I took a few minutes after reading the history to think about what I would do for this patient, then went back to the chart and looked at the plan the admitting resident had written. It was also valuable because it guided my history and physical when seeing the patient. 

For future rotations I would like to continue to work on my assessment and plan, before this rotation I had mostly seen ER or urgent care patients, where the focus was on the acute complaint. On my Long Term Care rotation I got to practice writing assessment and plans for patients for every aspect of their history. For example I had a patient admitted for pneumonia but she had a liver transplant and DM in addition, so my plan included treatment for pneumonia, assessment of how well her DM was controlled and a plan for that, as well as a plan for her liver transplant medications. On this rotation there were not many opportunities for procedures, so on future rotations I look forward to perfecting my procedural skills. 

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