Dr. Davidson, my site evaluator, met me at Gouverneur early on in my rotation for the first meeting.  I initially presented one H&P, five pharmacology cards as well as my procedure log.  Dr. Davidson and I spent a lot of time talking about the different patients I’d seen during my first two weeks and the multitude of co-morbidities these patients had (in addition to their presenting illness).  Unfortunately, my grandmother had fallen and broken her hip, requiring surgery, and we spoke in depth about the care she was receiving and how it was both similar and different to some of the care patients were receiving in the SAR facility at Gouverneur.  In reviewing my H&P, Dr. Davidson and I discussed a lot of the additional factors that a Long Term Care H&P requires in order to provide subsequent context as to the admission (and discharge).  The HPI for a Long Term Care / Geriatric patient requires details about why they were hospitalized, their hospital course, medications they received, requirements for rehab at discharge from the hospital as well as home settings and care plans for discharge from the LTC facility.  These H&Ps required significantly more details than those I’d previously written for my other rotations and Dr. Davidson and I discuss that factor and how important it is to provide all these details when constructing an HPI.  We talked about how the context in the HPI gives providers significant details allowing them to have a sound understanding of the patients medical history and to give patients the highest level of care.  The patient I presented during our first meeting was one that I ultimately wound up bonding with throughout my rotation.  He’d fallen in the Dominican Republic and came to the US for surgery and to live with his son after discharge from rehab.  This patient had an Occiput – C5 fusion, which I’d never heard of so his case was also great to expand my medical knowledge.  Polypharmacy can be a huge problem in geriatric medicine.  Dr. Davidson & I discussed this as we reviewed the medications I presented as well as how I had seen these medications used in practice.

Dr. Davidson returned to Gouverneur for our second meeting as well.  During this meeting we reviewed the remaining H&Ps, my pharmacology cards as well as the article I brought to review.  In this meeting I presented a patient that was quite complicated so we spent some time talking through the HPI to ensure she understood all of the moving pieces this patient’s care involved.  I worked to incorporate some of Dr. Davidson’s suggestions from our first session into the H&Ps I submitted at our final review session.  We talked about the importance of providing an assessment for each co-morbidity listed, which is not something I’d always done, as it highlights the current state of each issue and provides a subsequent plan moving forward.  The patient I presented had an incidental cancer finding after being admitted to the hospital and was in a SAR / LTC facility due to the mental decline she was experiencing prior to initial admission to the hospital.  Before we discussed the case, I reviewed my article about hip fracture fixation preferences.  I ultimately selected this article because it talked about the different types of surgical options there are for intertrochanteric hip fractures.  Many of the patients who were admitted into the Subacute Rehab facility for rehab and occupational therapy after surgical fixation and I was curious to learn about the different options after reading about them in the charts.  After reviewing the article and my H&Ps, we reviewed my last five pharmacology cards and discussed the wide variety of medications seen in the facility.  Given the large number of patients seen in this facility as well as the large number of patients Dr. Kolessa was responsible for, I was exposed to patients with varying medical needs and subsequent medications.  Dr. Kolessa was really knowledgeable about the medications and reviewed each admission to ensure there were not any drug-drug interactions and took the time to review the medications with me as well.  Finally, we reviewed my final procedure log and discussed the plan for the rest of this rotation as well as how to be successful in my final (!) rotation at the QHC Psych ED.

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