Dr Amy Radcliffe  -  11 August 2023

Starting my first shift in community geriatrics, I was unsure what to expect. Outside the familiar sterile walls of the hospital and without the reassurance of imaging, bloods and regular observations, I initially felt out of my depth. However, I quickly adapted: learning both clinical and non-clinical tips and tricks: the skill of subtly checking whether the seat was damp before you sat down in a patient’s home and dodging over-enthusiastic pets (try changing a catheter in sterile conditions when a chihuahua is trying to lick open leg wounds!) Imagine my shock horror when after deciding that IV antibiotics were indicated, I then had to proceed to try and draw up the antibiotics myself – the other ACP subtly laughing in the corner as I fumbled about with a giving set that I had not done since medical school OSCEs.

However, as my confidence and experience grew, I began to enjoy the freedom and variety of community medicine. One of my most poignant experiences was after reviewing a very polite patient at home who was mildly confused with a complex surgical background who had acutely deteriorated. The decision was made to admit to the local hospital as per the patient’s and his wife’s wishes. A week or so later during my acute medical on calls at the hospital, I was called to review an agitated aggressive patient on the ward- yup you’ve guessed it- it was the same patient. This previously extremely polite and pleasant man was now floridly delirious, pulling out cannula’s and spitting at members of staff. After spending over 60 minutes trying to manage the situation, I reflected that although we all know and tell patients and families that sending patients into hospital can cause/worsen delirium, to witness the stark deterioration first hand was very humbling.

On the other hand, the positives of making a diagnosis with very limited investigations and the satisfaction when this is confirmed and the patient has improved, is much greater than you ever experience in the hospital. It is a real privilege to be invited into people’s homes and to see a glimpse of their lives and listen to the stories they have to tell. Community medicine is similar to being a medical detective: using your skills to form a likely diagnosis but without the large comfort blanket that the hospital provides. I feel that as a medical trainee, this has been an invaluable experience particularly dealing with risk and identifying which patients are appropriate to send in vs those who would be more appropriate to treat at home. As we continue to see an aging population that is becoming increasingly frail with complex co-morbidities, community medicine is a rapidly growing specialty that currently medical trainees have very little exposure to.