Geriatric Home Assessment
Steven K. Swedlund, MD, and Richard W. Pretorius, MD, MPH, Boonshoft School of Medicine, Wright State University
The geriatric home assessment, a critical tool in treating patients in the context of their families and environments, inspires medical students to become compassionate physicians while simultaneously increasing their interest in the fields of family medicine and geriatrics.
At our institution for the past 5 years, every medical student participates in a minimum of one comprehensive, geriatric home assessment during their required third-year family medicine clerkship. The topic is introduced early in the clerkship by a senior geriatrician in a 3-hour workshop that covers the essentials of the successful home visit. Each student then is assigned a day and time to see a patient at home with one of our geriatricians or geriatric nurse practitioners. The patient is discussed en route to the home; the teacher-student team does a 1-hour assessment, and the student does a write-up following the outline that they had received earlier.
This activity, which consistently receives some of the highest ratings from the medical students, seems to resonate with Dr Francis Peabody’s immortal words, “The secret of the care of the patient is in caring for the patient” and reminds students of their own altruistic motivations for entering the medical profession. Several themes typically emerge for the students, each of which fulfills one of the ACGME requirements.
First, geriatric home assessments allow students to trial their newly learned skills in an everyday clinical setting, while under the tutelage of an experienced teacher. The one-on-one contact with a physician mentor allows the student to practice interpersonal communication and delivery of clinical care in a powerful way. (ACGME requirement: interpersonal communication skills)
Second, students usually experience more than one common geriatric syndrome and have the immediate need to apply knowledge about polypharmacy, fall risk, reducing/stopping medications as well as other principles of chronic disease management. (ACGME requirement: medical knowledge)
Third, students enter directly into the patient’s world and can compare how home-based care relates to office or hospital care in the continuum of care. (ACGME requirement: systems-based practice).
The students react very positively to the home visit in their comments: “It was definitely an experience seeing this side of medicine, and I’m glad I had the opportunity to. It’s difficult to truly understand the lifestyle of these patients just by an office visit, and home visits are necessary. It was an eye-opening experience.
They recognize the increased value of the enhanced patient-physician relationship and the increased clinical data through the home visit: “I greatly enjoyed this experience. I never realized how important it can be to actually see a patient in their environment, especially in geriatric patients. For example, since we actually were in her home, we could see all the naproxen on her dining room table and address that issue. If we had seen her in the office, I doubt that she would have mentioned anything about how much she was taking because it was “just all arthritis pills” to her. Seeing her and her husband at their home proved in one visit to be very important in order to properly care for this couple.
Finally, mentorship of medical students through geriatric home assessments inspires them in a way that technology and the biomedical model never can. Rather than teaching them compassion and patient-centered care in the classroom, why not just show them and let them decide if it is right for them. Out of a class size of just over 100, we conservatively estimate that this program motivates one additional student per year to enter family medicine and another to enter geriatrics. Try it—the results will surprise you!