Medical residents visit homebound

For the Monitor
Published: 4/22/2019 1:57:55 PM

I loved my grandparents. They were the heartbeat of our extended family and an incredible source of wisdom and comfort.

Those who choose to work with the elderly often cite early life relationships that resulted in a fondness for this particular demographic. As a final-year medical student, I used to stare at the ceiling and ask myself, “Do I want to be an obstetrician or a geriatrician?” I loved both! For this, I chose family medicine.

Based at Concord Hospital, the three-year residency program prepares us for comprehensive, full-spectrum family medicine practice. Now in our final year at the New Hampshire Dartmouth Family Medicine Residency, the eight graduating residents are gearing up for transition into independent practice this summer. For almost all, this will undoubtedly include caring for older adults.

The provision of quality comprehensive medical care to elderly men and women is paramount to any community. Aging is inevitable and is happening at a rate that our human society has never seen. It is estimated that by 2030, all baby boomers will have reached the age of 65 and that by 2035 there will be more people over the age of 75 in the United States than under 18.

At the residency program, geriatric medicine training begins in our family practice clinics as well as in the hospital. By second year, this continues with house calls as well as nursing home visits. In third year, the cumulative geriatric experience involves working with the “Frail Elder Program.”

Based at the Concord Hospital Family Health Center, the Frail Elder Program was established by internist and geriatric physician Dr. B.J. Entwisle. She and her colleagues have been providing comprehensive, interdisciplinary care to home-bound and nursing home dwelling members of the Concord and surrounding community for more than 20 years. Entwisle is a brilliant clinician and formidable teacher. Over the years, she has pushed every resident to see the full picture when caring for this often-fragile population.

The patient relationship begins with a comprehensive geriatric assessment, where residents are empowered to ask all questions relevant to a given patient’s health and quality of life. This often makes for memorable conversation! In addition to standard medical history taking, the resident is tasked with assessing things like cognition and mood as well as the patient’s ability to carry out essential activities of daily living – or ADLs. Often enough these interactions are laced with stories of their past and useful bits of life advice.

No two people are the same, and as such, everyone’s experience with functional decline and frailty is different. Thus a vital component of high-quality geriatric care is determining a patient’s overarching priorities: What is important to them? Does he or she believe in God? Is this person afraid of dying? If pneumonia strikes again this month are aggressive measures wanted? Are we caring or curing? The aggressively “curative” medical process is often a fast-moving train, and it can be excruciatingly difficult for both patients as well as their families to decide when it is time to get off.

As healthcare providers we cherish the opportunity to have these conversations and to know these people during a unique but often challenging phase of life. For the eight of us graduating this year, it’s a huge part of what makes family practice the greatest gig in medicine.

As for myself, I’d do it all over again.

( Dr. Brian McKenna is a third-year resident of the N.H. Dartmouth Family Medicine Residency.)

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