Session 73 Dr. Scott Harper is has been out of training for 8 years. He joined us to talk about his specialty, Geriatrics, and what he loves about it and more. Scott is in an academic medical center at Wake Forest Medical School. He shares with us his journey to Geriatric Medicine, what it takes to get there, things he likes the most and least, and more! And if you haven’t yet, please take a listen to all our other podcasts on MedEd Media! [01:24] Interest in Geriatric Medicine Scott traces his interest in the speciality back to when he was medical school, going through the clinic rotations. When he was working with patients he found he was most drawn to the extremes of age. He envisions his practice to include babies and kids to adults and people nearing the end of their life. When he was in family medicine for residency, he had an almost exclusively geriatric population in his clinic practice. He didn't feel he had the skillset to take care of all of their needs so this became his goal going into Geriatrics. During medical school, Scott recalls his grandfather entering the first stages of Alzheimer's disease and this bolstered his interest. He would visit him often and one day while he was riding with him in the car, he was stopping at every stop light regardless of the color of the light. He knew then that something was amiss. And he got to see how his disease progressed and the challenges that came along with it especially that family was not in the same town. [04:50] Traits that Lead to Becoming a Good Geriatrician Patience is critical to be a good geriatrician. You've got to be comfortable with things moving slowly. Most of the patients you will be taking care of move slowly and talk slowly. A lot of times, their content is very rich but doesn't come out in a rush. You also have to be comfortable with complexity. You have to be able to navigate all these things and understand that you may never have the perfect answer to what's going with the patient. Instead, you have to be able to tweak and optimize several different realms. "Patience, you've got to be comfortable with things moving slowly." By complexity, it may run the gamut of acuity, but not entirely. Scott describes the neat thing specifically about his job is he gets to do a lot of geriatric primary care. So he gets to see people for anything from infected toenail to Crohn's disease, management of 10-12 co-morbid conditions. Or sometimes, they'd have acute infections and they'd have to triage them into the hospital or the emergency room. There's other roles geriatricians play outside of primary care where you get to see different levels of acuity, which boils down to folks using medical services most often. If you're in the hospital as a geriatrician, you're going to be seeing a lot of acutely ill and complex older adults. Some geriatricians end up doing exclusively or a subset of the care in the nursing home setting or in a rehab center. Here, you'd be seeing folk who just came out of the hospital or moving in there for their final address. [08:05] Diseases Specific to the Older Population Scott explains this idea in geriatrics called Geriatric Syndromes, which are the end result of myriad processes that tend to commonly present in older adults. This occurs a lot in the primary care setting. Some of these diseases include memory loss, cognitive impairment, dementia, or somewhere along that disease spectrum and acute delirium. They may also deal with dizziness, imbalance, or falls. There are also osteoporosis, vision loss, hearing loss, urinary incontinence. "The way a person ends up with urinary incontinence may be very different than the way a different older adult ends up with urinary incontinence but the end result is the same." [09:05] A Typical Day Scott describes his day in the clinic seeing around 7 to 10 older adult patients in any given half day. He spends an average of 30 minutes with each of them. Most of them are there for regular check ins, where he