Lisa Norton, a geriatrician and clinical assistant professor at Boston University School of Medicine, starts her day with a home visit, accompanied by her student, Eugene Lee. Their patient is Pauline Harris, an 87-year-old woman living in the South End, grappling with multiple health issues. Before buzzing into Harris’ apartment, Norton mentions a key challenge: medication non-compliance. This initial detail sets the stage for understanding the critical role of home care in geriatrics.
Upon entering her home, Pauline Harris welcomes Norton and Lee with warmth. In her living room, filled with personal items and religious prints, the medical professionals begin their assessment. Over the next hour, Norton and Lee engage with Harris, asking pertinent questions, drawing blood, and meticulously checking her vital signs. This detailed interaction is a cornerstone of the Boston University (BU) Geriatrics Home Care Program.
Norton is part of a dedicated team of six geriatricians and nurses within the MED’s Home Care Program. This program extends its reach to approximately 570 patients who face difficulties in leaving their homes for medical care. Remarkably, the Bu Geriatrics Home Care Program is the nation’s oldest of its kind, integrated into the university curriculum since the 1870s. Fourth-year medical students benefit from a month-long geriatric rotation, learning core practices and attending lectures that span from insurance complexities to end-of-life care. This program exemplifies Boston University Medical School’s commitment to community engagement and practical medical education.
During the home visit, Lee inquires about Harris’ breathing, balance, and dietary habits, while Norton diligently records observations on her laptop. Norton’s attention to detail extends to the patient’s environment; she notes the numerous items in the apartment and subtly inquires about Harris’s medications. Harris eventually points to several medication cards, months out of date and completely empty. This discovery confirms Norton’s suspicion of medication non-compliance and underscores the insights gained through home visits that might be missed in a typical clinic setting. Furthermore, observing Harris’s home environment reveals her Christian Scientist beliefs, another crucial piece of her holistic health profile.
Lisa Caruso, another MED assistant professor of geriatrics, emphasizes the profound insights gained from these home visits. Doctors can assess a patient’s ability to manage daily living – navigating stairs, stocking their refrigerator, and managing their medications. This comprehensive understanding is invaluable in geriatric care, allowing doctors to see the bigger picture.
The need for specialized geriatric care is increasingly urgent. The American Geriatrics Society reports a significant shortage of geriatricians—approximately 7,100 board-certified professionals nationwide. This number needs to dramatically increase to meet the healthcare demands of the rapidly aging population, with over 71 million Americans projected to be over 65 by 2030, according to the American Medical Student Association.
Geriatrics, however, is not always seen as a glamorous or high-paying specialty. Data from the Medical Group Management Association indicates that geriatricians’ average salaries are considerably lower than those in more specialized fields. The work is often described as a “labor of love” by doctors at Boston Medical Center (BMC), BU’s primary teaching hospital. They are passionate about geriatrics and utilize the Home Care Program to inspire medical students, hoping to reveal the intrinsic rewards of this field. Daniel Oates, medical director of the Home Care Program, aims to cultivate an appreciation for geriatrics, even if students choose other specialties later. The experiences gained in the program are meant to enrich their future medical practice, regardless of specialization.
During the visit with Harris, Lee and Norton work together to resolve the medication issue. They discover that Harris’ medication deliveries were paused months prior, explaining her inconsistent medication intake. While Lee contacts the pharmacy to rectify the situation, Norton proceeds with a blood sample collection. This collaborative approach highlights the team-based nature of the BU Geriatrics Home Care Program.
Geriatric patients at BMC often present complex challenges. They are typically in their mid-80s, live with limited financial resources, and rely on subsidized health insurance. Many also face language barriers. Complicating matters further, they frequently manage multiple chronic conditions, each requiring specific medications. Geriatricians must possess expertise in understanding drug interactions, especially in elderly patients, and recognize that common illnesses may manifest differently in older adults.
Oates stresses that elderly adults are sometimes marginalized or overlooked. He emphasizes the importance of a team approach in geriatric care, involving various specialists to address the multifaceted needs of older patients. Effective communication is another critical aspect. Oates conducts workshops to train students to communicate clearly, avoiding medical jargon, especially when speaking to elderly patients, considering that a significant portion of the population has limited health literacy. He advocates for the “teach-back” method to ensure patient comprehension of care plans.
Ultimately, Norton emphasizes the importance of listening to the patient. Despite medication inconsistencies, Harris reports feeling well, and her vital signs are stable. This prompts Norton to reconsider Harris’s medication regimen, prioritizing the patient’s overall well-being over strict adherence to protocols.
In conclusion, the BU Geriatrics Home Care Program exemplifies a holistic approach to elderly care. It not only provides essential medical services to home-bound patients but also offers invaluable training for future physicians, emphasizing empathy, comprehensive assessment, and patient-centered care in geriatrics. For Norton and Lee, as they leave Harris’s apartment to continue their rounds, the focus remains clear: understanding and prioritizing “how the patient is doing.”
