I believe that I was better prepared for my experience at Gouverner’s skilled nursing facility because I had my internal medicine rotation prior. I found that the style of running both floors were similar, in addition to how attendings wrote notes. However, the patient demographic that I encountered were of older age, usually aged 65 and above, which is suiting for my long term care rotation. Because many of my patients had various degrees of dementia and were incapable of taking care of themselves, eliciting information was a little different. I learned to be more patient, ask questions in a variety of ways, and make use of caregivers that knew the patient well to establish what the baseline of the patient was in comparison to how he or she was presenting at the time. Conducting the physical exam was also a little different as it was important to assess mental status and due to motor limitations that the patients may have.

Prior to this rotation, most of my patients were alert and orientated to person, place, and time so I found that history taking was more efficient. Sometimes, the patients would repeat themselves many times or the history would not make sense so it was important to determine when to move onto the next part of the examination. I also learned how to remove staples for the first time (pretty amazing how I have not encountered it thus far into rotations!) My preceptor was patient with me as he taught me new procedures and I was able to watch how he interacted with his patients. What I found particularly significant was how he listened carefully to the patients, addressed what their concerns were, and reassured them what the next steps were and that they were in goods hands to not worry. This was especially important as our older patients may have forgotten what we had said earlier or they processed information more slowly. Little details like this helped our patients feel less anxious and more optimistic about recovery.

I also improved in my ability to write a full H&P in a less amount of time, which I feel is an accomplishment especially since most of my patients had extensive past medical and surgical histories. It was especially helpful to look at previous admission details for example, any recent visits to the ER or a similar setting to better understand why a patient was sent to the nursing facility and how to better manage that patient. Overall, my experience in long term care was rewarding and valuable as I continue to gain an arsenal of skills to prep me into becoming an efficient, but thoughtful PA.

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