I did my long-term care rotation at Gouverneur Skilled Nursing Facility. At Gouverneur, I saw how each patient was cared for by a multidisciplinary team. The team usually consisted of a physical therapist, occupational therapist, speech-language pathologist, dietician, nursing staff, physician, and social worker. They came together to deliver more comprehensive care for each patient. On the subacute floor, I saw patients actively engaged in different rehabilitation activities provided by different healthcare professionals. During my time at Gouverneur, I was coached by a physician covering one of the subacute floors. Most of the patients were elderly with very complex medical histories prior to being admitted. My preceptor showed me how to interview and do focused physical exams based on the patient’s complaint. He would go over patients’ lab results with me and taught me how to write detailed patient notes. In the beginning, I found it difficult to write admission notes because the prior hospital course can be very long and complex. My preceptor showed me a few examples and taught me how to select the important details and condense the information. All the nursing staffs I met were very helpful and willing to teach me procedures like dressing change, IVs, EKGs, etc.

The facility also offers palliative care to patients with terminal illnesses. It can be an uncomfortable conversation to start with the patient or their family members. One of the newly admitted patients was discharged from the hospital after being treated for urosepsis. Since admission to Gouverneur, she showed no sign of improvement and the Chief Medical Officer was having the conversation with her family about palliative care. When the patient was discharged, the hospital said the patient was stable, and they had the option of taking her to a skilled nursing facility or taking her back home. The word “stable” and the option of “taking her home” made the family think that the patient was recovering well. Therefore, the family was very shocked at the beginning when they were discussing palliative care. During the discussion, I saw how the SPIKE strategy was implemented, and the doctor was able to gain the trust of the family by answering their questions honestly, explaining what palliative care means and what services would be given in this situation. From this conversation, I learned it is important to talk slowly and confidently, give honest answers, show empathy, and give the family enough time to digest all the information.

I think this is a good rotation to start with because I gained a lot of practice in interviewing patients with complex histories and writing notes in a relatively slow pace environment.