I was struck after my 2-week geriatrics rotation ended last week, because I found myself thinking that it was a specialty that most aligned with my core values of practicing medicine, and its approach to patient care was very unique compared to other clerkships I rotated in. This was realized after one specific clinical experience on my last day of the clerkship, in the Cognitive Care clinic. It was made apparent to me that patient preferences trump everything else especially in this field, where the quality of life is so important. As medical professionals, we are taught to prioritize patient autonomy over everything, but I have not seen that as respected anywhere else as geriatrics. The fellow I worked with made sure to ask permission before delivering any news to the patient and his family, which was unlike the usual immediate offloading of information to patients that I normally witnessed, and did myself. He would ask, “Is it okay if I interpret your test results?” and “Is it okay if I talk more about your diagnosis?” In the end, the family wished not to honor the diagnosis of Alzheimer’s or take advantage of the resources associated with the diagnosis, because of their perceived stigma related to having the label. The attending discussed with me at length that often times, patients and their families will deny the diagnosis initially, but eventually come around when they become more accepting and seek resources and help. I was intrigued by how much we integrated patients’ opinions during these visits, and how we let patients drive the course of the visit.
