The Bitmoji Doctor

Geriatrics ain't it for me…

For so much of this year, I have been coy and undecided about which area of medicine I'd want to pursue, having not completely ruled out any specialties. Geriatrics was different, though; I just can't see myself working consistently with the elderly-- not because I don't like them, but for me, geriatrics was a little too slow. The medicine and the complexities of the patients were interesting and definitely kept me thinking about possibilities; however,, I didn't see the variety I sought. That could just be due to the particular rotation that I was on, but I now know that variety in practice and applicability is something I am seeking in a career.

I think, to add, the year is finally catching up on me. During this rotation, I started to feel a little bit more jaded, and going from psychiatry to geriatrics was a different scene. Only having a two-week break in the middle of the year and going nonstop from Australia Day until the end of November makes you feel a certain type of way, and I'm starting to feel that tiredness. But, we're nearly there…

More common issues present with geriatrics are that of end of life, power of attorney, and medical and lifestyle concerns. I didn't know what these entailed at the beginning of the rotation, but it's been clarified because there are subtle differences between the aforementioned. In whatever specialty, though, there will be elderly patients, so it was essential to get the basics of end-of-life issues, as well as the underpinnings of dementia and delirium, and the differences between them.

Every day on my geriatrics rotation was quite similar. The mornings would be filled with ward rounds, the longest in my short experience of placements. Then odd jobs would be completed in the afternoon, like following up on different blood results, clarifying medical history from GPs and other specialists, writing notes, and most importantly, being the coffee runner for the doctors. These are all critical skills to understand because there's a way and method to be followed, just like when my mum makes her famous injera—you can't miss any steps! It was the first time I was on placement with medical students from other universities, and to be honest, I didn't mind having them around. One of them joked that I was from the enemy university and stealing experiences from the students in their university. Enemy? Ma'am, I'm just here to learn about geriatrics and get some free coffee. I'm not the enemy!

I was also seen as different in an entirely separate way. My entire team comprised four female doctors, one other Asian medical student, and myself. This was one of the most diverse teams I've had the privilege of being on. We went to see a patient, as you would on a morning ward round, but encountered some slight difficulties. A patient didn't want to be seen by anyone on our team; he wanted a “tall, white, male doctor”. Their request thereby excluded every single person on our team! This patient wanted a doctor like he was choosing and creating his bitmoji, stating all the features on his personalised emoji. He would be the type of guy that wouldn't have any people of colour for his apple emojis or even have dark mode for his computer and phone settings. Eventually, we had to call another team with the credentials that matched the patient's description to attend to him.

In a way, it made me realise that the usual norm is changing. If a team consists of medical practitioners that don't fit that description, diversity is no longer an anomaly but slowly becoming more integrated into medicine. It still has a long way to go, and I wonder what will happen in 20 years' time when- hopefully – there's an entire team of black people, and that's the only option!

I did appreciate the immense knowledge shared on this rotation by my consultant geriatrician on dementia and delirium. She's a top dog in the dementia professional space. She has done extensive research on all things relating to dementia, from treatment to prognosis, and education of medical staff on its complexities. Whenever the entire team was on ward rounds, she always found learning experiences to instil into me, and I grasped it all like it was “my precious”.

I liked how she was thorough and deeply concerned about the little details of every patient she encountered. This was highlighted time after time when she would go on her thought train and take us on a journey of her reasoning for organising tests, referring to allied health professionals, or suggesting one type of outpatient service instead of another. As a medical student, I found it invaluable, as oftentimes, the clinical reasoning and judgment employed need to be understood. This reminded me of my GP rotation where my GP consistently mentioned the importance of justifying what you are doing and why .

Additionally, my doctor had one of the most pleasant bedside manners with her patients, which I think I might utilise with my future patients. She didn't tower over her elderly patients, and always ensured eye-level conversation with them, even if it meant bending down on her knees to achieve this. She spoke clearly, concisely, and with a tone that was so confident and convincingly reassuring—the medical equivalent of a Morgan Freeman type of voice. I asked her about it one time, and she said, “when you get to that age, and need treatment, we'd want someone to treat us with respect. It's important we do the same now”. So, so true.

I've been helping some friends with medical school interview preparation outside of medicine, which is fun. It makes you realise how quickly time goes, because what seems like it was only a moment ago, has been three years, where I was in exactly the same position, looking from the outside in. To finish off what is an endless year of rotations, I have obstetrics and gynaecology, and then end of year exams. Lord, help us. So, so close to the end of the penultimate year. I cannot wait to go on a lovely, lengthy holiday and see my girlfriend. I haven't seen her in so long; I'm beginning to forget what she looks like! Can anyone in Canberra remind me again?

Thanks for sticking around until the end of this post. I hope you are all well, being appreciative of the things in your life and I hope you all continue eating those pancakes.

Anei.