Friday, December 12, 2008

End of Geriatrics

I'm now officially done with geriatrics. This week was similar to the first week: seeing inpatients in the morning and outpatients in the afternoons. I did get to observe a driving test one morning, which was an interesting experience. A psychologist conducts the interview, and if the patient passes that portion of the exam, then they go out into the lot for a driving test.

The patient was a very sweet man who insisted that he could drive just fine, and he didn't understand what the fuss was all about. He seemed perfectly normal to me when we were chatting before the interview. The psychologist performed the mini-mental on him, and he got all of the questions right except for missing a couple of items on recall. Then the tests got harder. The psychologist asked him to name as many animals as he could, look at pictures, and answer other questions. As I watched and listened, it became apparent that this man really was mildly demented. The questions he was struggling with were mental tasks that no one should have had trouble doing.

In spite of performing poorly on several of the tests, the patients still insisted that he was fine to drive. This is an example of lack of insight, which is common in Alzheimer's patients. In other words, he did not recognize his own loss of memory and other cognitive abilities. Patients with some other forms of dementia (non-Alzheimer's) do sometimes retain insight and are aware that their thinking has declined.

Ultimately, the psychologist asked him about things like how many tickets he had gotten recently, and how many accidents he was in recently. It turns out that there were some of each. The patient's cognitive decline was apparent enough that no driving test was necessary. He was told that he had to give up his license, which unsurprisingly upset him. It was very sad.

The only other new thing I did this week was to go to UH to do some consults on inpatients. I hadn't ever rotated at UH before, and it was very trying. First of all, they don't have electronic charts. You wouldn't think that would matter very much, but it does when you're trying to read about a geriatric patient whose chart weighs more than you do! It didn't help that a bunch of papers were randomly stuffed in there every which way, and half the notes were scrawled in chicken scratch that I couldn't read. Making sense of it all was hard enough that I only saw two patients all afternoon, even with staying an extra hour. (The attending wanted me to stay even longer, but I had more than run out of patience by then.) All in all, this experience made me greatly appreciate how much nicer it is to use electronic medical records like they have at the VA and at CCF!

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