Texas Medical Students Learn About Older Patients
DALLAS (AP) – A young man in a lab coat knocks on the door of room 221. He enters and shakes Agness Robertson’s hand. The two sit side by side. Robertson tells him of her decades of marriage, flipping through photos and handing him newspaper clippings of her career as a society columnist.
Second-year medical student Patrick Snyder pulls out a stethoscope and listens to her heartbeat.
“I am so glad UT Southwestern is doing this. Some doctors are just boing-boing-boing,” she says, mimicking a check-marking motion, “and then they’re gone.”
Snyder joins about a dozen classmates from the University of Texas Southwestern Medical School. Only this time, they make rounds in an assisted-living facility instead of a hospital. At the Legacy at Preston Hollow, they collect medical histories and life stories. Some set foot in a nursing home for the first time.
The field trip reflects the medical school’s broader effort to teach students about the needs of an older population — an endeavor that puts the school ahead of most, says Dr. Sharon A. Brangman, president of the American Geriatric Society.
Despite the demographic shift ahead and a nationwide shortage of geriatricians, few medical schools have any geriatric requirement, she said.
“The goal of medical schools is to train the next generation of physicians,” she said. “And I don’t think they will be adequately trained if they are not taught geriatrics.”
The Southwestern Aging and Geriatrics Education program, funded in part by a $2 million grant by the Donald W. Reynolds Foundation, folds geriatric topics into the medical curriculum and students’ studies, regardless of their specialty.
“From Day 1, we want them to be thinking about aging,” said Dr. Craig Rubin, chief of geriatrics.
One of the first lectures focuses on aging in anatomy class, he said. Students meet a senior mentor during the first year of medical school. Throughout their studies, professors quiz students on geriatric-related concepts and talk about preventing miscommunications or medical errors when transitioning a patient out of the hospital to a new home such as an assisted living or skilled nursing facility.
Seeing a need, the Reynolds Foundation began awarding such grants in 2001, said Rani Snyder, program director for health care programs at the Reynolds foundation.
“Most physicians do not have training in geriatrics,” she said. “It could make an enormous difference to older people nationally.”
Interested schools must raise $1 million of their own and prove that they have an institutional commitment and a way to sustain the program once funding runs out, she said.
For UT Southwestern, grant money has helped pay faculty to rewrite the curriculum, weaving geriatrics into existing courses, said Rubin. It has also funded special projects, such as a medical artist who created computer programs about aging skin.
“We’re attempting to change the culture and integrate this so it becomes the infrastructure of the school,” he said. “The curriculum that we’ve started will become self-perpetuating.”
Back at the Legacy, the students draw strips of paper with a room number and name.
“They really are a fun population,” Jayne Doyle, the building’s social worker, tells the students. “We’ve had a Broadway actress. We’ve had athletes and a lot of really fascinating stories — if you listen to them. They’re a great way to practice your bedside manner.”
Snyder heads upstairs to room 221, for what he later called “an eye-opener.”
Snyder grew up near Austin and attended Rice University. He majored in mechanical engineering but walked out of his first job interview and began pursuing medicine.
His grandmothers both had cancer. One died from breast cancer, and the other fought ovarian cancer. “I had a personal vendetta to get back at the disease,” he said. That vendetta led him to oncology.
Robertson worked for years as society columnist for Park Cities People. Her husband worked by her side, snapping photos at galas, banquets and parties. With his declining health, the two retired and moved into the Legacy at Preston Hollow.
Since then, she’s become a widow and has lost her vision from macular degeneration. Now the remnants of her career are newspaper clippings, photos of famous Texans including President George W. Bush and a recent story about an Elvis impersonator printed in the building’s newsletter.
The visit was less about medical details and “more about her life story, her articles, and her deceased husband,” Snyder later recalled.
“The human aspect came out,” he said. “It was the first time I really thought about what it would be like to be in the position myself.”
She “was a social butterfly and threw so many parties and now the world that was at her fingertips, she didn’t have access to it without her son.”
Around a patio table, a small group of students shared similar stories with Dr. Belinda Vicioso, a geriatrician and professor. She asked them about their own experiences with elders, about their relationships with grandparents and if they’ve visited a nursing home before.
“My mission here today is to teach you how to love taking care of seniors,” she says.
Vicioso emphasized the different needs of residents in an assisted living facility. The goal is improving the quality of life, she said.
Observation is important, she said, describing a number of common scenarios:
If an older patient is hospitalized and acts confused, a nurse might call the doctor and ask permission to sedate her. Yet if the doctor knows about the patient’s impairments, he or she would look for missing glasses or a hearing aid first.
Fluffy couches can be harder to lift out of than a chair with more back support, she said. A patient that complains of back pain may need a new chair instead of a prescription.
A month later, Vicioso returns with a different group of students. In a small, sparsely decorated room, they gather around the bed of a frail older woman. Vicioso reaches for her hand and helps her shift to a comfortable position.
“Do you see why I love my job?” Vicioso says aloud on her way out the door. Then she leads her entourage down the hall.
(Copyright 2010 by The Associated Press. All Rights Reserved.)