A silver lining in medical training

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

More often than not, the patients we interview and examine as medical students (and beyond) are elderly. But there’s little frank discussion during our training about the particular challenges, and joys, of such encounters. Dr. Anne Fabiny chief of geriatrics at Cambridge Health Alliance, and her geriatrician colleagues at several Harvard-affiliated hospitals, are hoping to change that.

On Wednesday afternoon, our Patient-Doctor class paid a visit to the BIDMC simulation center, tag-teaming interviews with patient actors while preceptors and other classmates observed behind a two-way mirror. After a lecture on the dos and don’ts of elder care (eg. Speak with elderly patients with large volume and low pitch, since high notes are the first to go), we took a field trip to the Hebrew Rehabilitation Center in Roslindale to test these skills on real patients.

I met Ms. R, a chatty 89-year-old woman who was more than happy to offer her story, or her de-stockinged leg, for the cause. Her back was stooped with severe osteoporosis, revealing the years that were belied by her still-brown hair. Attuned to the lessons of the afternoon, I chose my words carefully and enunciated them vigorously. My partner and I took time to ask about her medications, since we'd been told that drug complications should be blamed for health problems in the elderly until proven otherwise. (Misunderstanding a doctor’s orders can be dangerous too.)

We focused our questions on Ms. R’s daily activities at the center, remembering that quality of life trumps extending life in elderly care. In our final minutes with Ms. R, I watched as our geriatrician preceptor devotedly attended to Ms. R’s ulcerated foot, and took a mental note to emulate her approach.

The session reminded me that long lives make for fascinating, if complex, patient interviews. Though it’s not the the trendiest specialization, it's one that seems to attract some of the most passionate providers. And in the end, we all benefit from more attention to geriatric care -- whether as practitioners or, eventually, as patients.