Thank you for facilitating a discussion of the geriatrics home visit. At least one of your students has completed a home visit with a geriatric patient that he/she encountered earlier during the clerkship. This is not the students' first home visit with a patient. Each student has completed at least one home visit in the ICM series and will complete a second one during the Family Practice clerkship. The student has discussed many items with the geriatric patient and the patient's caregiver and has written a reflective paper on the experience. The student will submit this to you instead of one write-up.
Broad, general objectives of the geriatrics home visit
1. To determine whether a geriatrics home visit changes student attitudes towards geriatric patients
2. To determine whether a geriatrics home visit program augments student knowledge of geriatric syndromes
More specific goals that the student may accomplish include
1. Continuing to develop an appreciation of health care in the context of the patient's life.
2. Allowing the student to learn some geriatric assessment techniques.
3. Gaining a better perspective on chronic diseases and the physician's role in managing them.
4. Discussing end-of-life issues with a patient they know.
5. Improving understanding of the physician-patient relationship.
The student will complete the Geriatrics Home Visit Write-up. This assignment takes the place of one write-up. Obviously this write-up will be quite different from the other four and should be evaluated on different criteria. The student will provide the clinical information collected during the home visit to the ward team (inpatient students) or the patient's outpatient physician (ambulatory students).
After the student turns in the write-up, debrief the student with your precepting group. This is a terrific opportunity for a student to be an "educator" because he/she may be the only student to do have done a home visit in your group. Ask them to lead the discussion, what measures they performed, and why. You may consider covering some of these discussion questions:
1. Ask the student to describe the patient and the patient's caregiver.
2. What did you notice about the patient or caregiver's values and beliefs?
3. How do you think the patient's situation might affect health care for them?
4. What insight did you gain about relating to patients as a physician?
5. What questions could you ask in a clinic or hospital to elicit an understanding of what life is like for geriatric patients and their caregivers?
6. What medications does this patient take? What are the management issues for the patient and physician about medications?
7. What are the main areas of vulnerability or risk that are relevant to this patient? What are the implications for management of his/her care?
8. What resources or special care does this patient need and what is the physician's role in helping the patient obtain them?