Session 110 Geriatric medicine is both stimulating and satisfying for Dr. Shannon Tapia. We’ll talk about housecalls, mortality, and the importance of having a sense of humor. Meanwhile, be sure to check out all our other resources on Meded Media for more help as you journey along this awesome field of medicine! Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:20] Interest in Geriatrics Having a father who's a geriatrician was Shannon's first exposure to medicine. Growing up, medicine was different back then but she got to witness how it was being a physician. She liked the cognitive aspects of medicine. She could do procedures but she just never really got stoked about it. Being exposed to it early on and realizing how cognitively challenging geriatrics is, she was essentially drawn to it. Shannon compares geriatrics with being the Sherlock Holmes of doctors. Aside from a huge kinetic variability if they live long enough, they also have a lifetime of choices. With geriatric patients, many of them could be suffering from dementia and other cognitive issues, making it difficult for them to express how they feel. So geriatricians have to get a collaborative history from their family and know the environment.  Shannon finds this to be very interesting, challenging, and satisfying. Half the time, it's med side effects from the specialists. They throw a med at them which they should never have been on. You will also realize there's not an answer so you need to be working with the patient and their family. It basically covers all aspects of medicine. You have to be constantly thinking of options and navigate it with your patients and their families. [05:00] Types of Patients The majority of 30-50-year-olds are rare diagnoses but most of them present pretty similar cases. They come in and the doctor asks appropriate questions and they give an accurate history for the most part. This excludes people who are actively psychotic. In the older population, you have to expand your differential in what they say because a lot of things present differently. They have dampened immune systems. They have neuropathy and they don't feel pain in the same way. Until you spend a lot of time with your geriatric patients, it's hard to truly describe the extent of how different it is. You're essentially dealing with a variety of factors when you're trying to approach a problem. Then there are a lot more limitations on what the achievable goals are. So you have to reconcile those to arrive at a realistic outcome and that people can be comfortable with. [07:19] Traits that Lead to Being a Good Geriatrician Shannon says that having a healthy sense of humor is good. You have to be patient and not afraid to get into the thick of things. You never know what you're going to walk into half of the time. Don't take things too seriously otherwise you're going to end up missing what the patient really needs and that of their family. Being empathic and being comfortable with mortality are two other important traits of a good geriatrician. Shannon believes that if you're not someone who can stop doing things to people, you should not be a geriatrician. There's this mentality in medicine where doctors intervene when there's a problem and they're going to fix it. As patients get older, the only truth is we all die. There's always more we could do but you have to be able to step back. Think about the quality of life and prognosis for the patient if you did it. How would it look like not only after they recover but also in two years down the road? Essentially, you have to take it one patient at a time and take their goals and preferences at a time. Have your opinions but separate yourself from that. Moreover, there's a lot of misinformation even for geriatric patients and their families as to what's achievable in medicine. You have to get to know both the patient and their family. Be honest with them about w