For my final site evaluation, I presented the case below which I have also uploaded under my H&P section.
Case: 84 y/o Filipino female living with her daughter and independent in all ADLs with a PMHx of Asthma, Gallstones, GERD, Osteoarthritis and Cataracts presented with her daughter to the Geriatric clinic today for her first visit to establish care. Her daughter states that the patient had travelled to the Philippines for vacation but had to remain there for the past 3 years due to the pandemic and the lockdown
As described in the case scenario, the patient is an elderly patient that formerly received care in the U.S. but due to the consequences of the Covid-19 pandemic had to remain in lockdown in the Philippines. The patient presented to the clinic to establish care here for the first time. She had a few complaints as described in the full H&P but her major complaint was poor vision due to a hx of age-related cataracts. The patient was previously recommended cataract surgery which she declined due to a fear of surgery and the outcomes, especially with her advanced age. As for other ongoing conditions such as degenerative joint disease, asthma, and GERD I developed my plan to address all these issues and also addressed her healthcare maintenance and screening needs.
The feedback I received from my site evaluator on my assessment and plan was the need to perform a more thorough interview on patients and the need to ask more questions to get a better understanding of the patient’s problems. For example, the patient stated that she had GERD, but I did not explore further the extent to which the patient’s GERD was affecting her life. I was quicker to want to prescribe a treatment for the patient than determine how much the patient was affected by the condition and whether she needed a daily medication or a milder prn treatment.
With the Geriatric population I know that polypharmacy is a major problem and moving forward I will do my best to be more intentional about my interviewing and my decision to prescribe medication.