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Rapid Responses: Rapid Responses published:
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Will either general medicine or geriatrics survive as specialties?
- Peter N Black (7 July 2008)
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Only generalists can make the diagnosis that the emperor has no clothes
- oscar,m jolobe (10 July 2008)
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No argument?
- Lewis G Morrison (12 July 2008)
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Should geriatric medicine continue to exist
- David Oliver (12 July 2008)
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Should Geriatric Medicine remain a speciality?
- Celine M Aranjo (12 July 2008)
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Why Geriatrics
- Peter Crome, UHNS, Stoke on Trent ST4 7QG (12 July 2008)
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Geriatric Medicine is the future of General (Internal) Medicine
- Manfred Gogol (17 July 2008)
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'Older People' not 'Geriatrics'
- Rodger C Charlton (18 July 2008)
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Geriatricians can help the medical profession get to grips with the ageing agenda
- Adam L Gordon, Adrian G Blundell, and Rowan H Harwood. (19 July 2008)
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Re: Will either general medicine or geriatrics survive as specialties?
- Gerard J. Ligthart (21 July 2008)
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should geriatrics remain a specialty?
- Sirish Vasireddy, Anne-Louise Bridge and Jeremy Snape (23 July 2008)
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Should General Medicine remain a specialty
- Jeffrey TJ Rowland (25 July 2008)
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Re: Will either general medicine or geriatrics survive as specialties?
- Rowan H Harwood (7 August 2008)
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Geriatric medicine should remain a specialty
- Hammad Akram (8 August 2008)
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Geriatrics is a broad spectrum part of medicine
- Feroz M Shah (9 August 2008)
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Internal Medicine: a specialty in extintion
- Roberto S Salinas Durán (23 January 2009)
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Peter N Black, Associate-Professor School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Leon Flicker argues that geriatric medicine should remain a separate specialty because elderly patients benefit from the knowledge and skills that geriatricians have in managing frailty [1]. Charles Denaro and Alison Mudge propose that the distinction between general medicine and geriatrics is now artificial and that all physicians need to be able to manage the increasing numbers of elderly patients with multiple chronic diseases and disabilities although they acknowledge the role of geriatricians in championing comprehensive assessment, multidisciplinary care and planned discharge [2]. To some extent the debate is artificial. All general physicians need to be able to manage frail elderly patients with multiple co-morbidities. At the same time it is likely that there will still be an important role for geriatricians who will continue to have greater expertise than other physicians in areas such as rehabilitation, dementia and falls. The real debate is whether generalism will survive at all or whether all hospital physicians will become subspecialists. The increasing numbers of elderly patients with multiple medical problems who present to hospital with acute illness suggest the need for increased number of generalists. At the same time it is becoming harder to attract trainees into careers in general medicine or geriatrics. They are increasingly interested in working exclusively in a subspecialty such as cardiology or gastroenterology. Denaro and Mudge allude to the problems with recruitment in geriatrics. This is also the case for general medicine. General Medicine is perceived as hard work with onerous on call responsibilities compared with other specialties but with lower status and fewer rewards. In the United Kingdom the number of physicians participating in acute general medical rosters is falling [3]. The situation may well be worse in Australia and New Zealand [4] and Canada [5] where recent reports have highlighted problems with the recruitment and retention of general physicians. If generalism is to survive within Internal Medicine there is need to improve the both the status and working conditions of general physicians and geriatricians. A failure to do this may mean that patients are managed by a committee of subspecialists because there is no-one left to deal with the whole patient. Those responsible for the management of health services need to take urgent action to address this problem. 1. Flicker L.Should geriatric medicine remain a specialty? Yes. BMJ 2008; 337: a516, doi: 10.1136/bmj.39538.481273.AD 2. Denaro CP. Mudge A. Should geriatric medicine remain a specialty? No. BMJ 2008; 337 :a515, doi: 10.1136/bmj.39533.696076.AD 3. The Federation of the Royal Colleges of Physicians of the United Kingdom. Census of Consultant Physicians in the UK, 2005. Data and Commentary. http://www.rcplondon.ac.uk/professional- Issues/workforce/Documents/2006-consultant-census.pdf 4. Royal Australasian College of Physicians. Restoring the balance: an action plan for ensuring equitable delivery of consultant services in general medicine in Australia and New Zealand. 2005. http://www.racp.edu.au/page/health-policy-and-advocacy/workforce. 5. Canadian Society of Internal Medicine. Care-fully: Defining a plan for General Internal Medicine in Canada. http://csim.medical.org/content/2005/CSIM_GIM_Manuscript_Oct- 2005_Final.pdf Competing interests: None declared |
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oscar,m jolobe, retired geriatrician manchester medical society, c/o john rylands university library, oxford road, manchester, M13 9PP
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The story is told that Einstein made his most fruitful challenges to conventional wisdom, including the conventional wisdom that electromagnetic waves were propagated in "ether", during his years as a "generalist", working in a patent office in Zurich, outside the restrictive orbit of academia, the latter characterised by the pressure to conform(1). An analogous situation exists vis a vis general medicine and its various subspecialties, and generalists, being under no pressure to conform, are sometimes in advance of specialists in challenging conventional wisdom generated by specialists themselves. Accordingly, it came as no surprise that it was a generalist who challenged the conventional wisdom of equating left ventricular dysfunction solely with subnormal left ventricular ejection fraction(1), and this was two years in advance of a cardiologist expressing the hope that "one day we will be no more likely to classify patients with heart failure by ejection fraction than we classify patients with cancer by haemoglobin level"(3). Generalist, by definition, are uniquely placed to see the big picture, and subspecialisation, by the same token signifies focus on only part of the picture, sometimes at the risk of a distorted interpretation of the whole, the whole, in this instance, being the entire patient. References (1) Isaacson W Einstein : his life and universe.2007 Pocket Books Simon & Schuster UK Ltd Africa House 64-78 Kingsway London WC2B 6AH (2)Jolobe OMP Usefulness of left ventricular ejection fraction in patients with overt heart failure(letter) Mayo Clinic Proceedings 2006:81:1638-9 (3) Manisty CH., Francis DP Ejection fraction: a measure of desperation? Heart 2008:94:400-1 Competing interests: None declared |
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Lewis G Morrison, Consultant Physician in Geriatric and General Medicine Roodlands Hospital Haddington, East Lothian EH41 3PF
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Having read Professor Denaro and Dr Mudge's cogent piece "No", and in particular the following: "There is little point in continuing to distinguish general physicians from geriatricians". "A patient's continuity of care should be maximised" and "There has been a renewed impetus to increase the number of generalists in hospitals", I would like to thank the authors wholeheartedly for arguing so strongly FOR the specialty of geriatric medicine. Competing interests: Consultant Geriatrician |
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David Oliver, Senior Lecturer, Geriatric Medicine University of Reading, School of Health and Social Care, Reading, UK
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Editor There is much common ground between the protagonists in this slightly phoney war. Both parties agree that the core business of healtchare will increasingly be the care of frailer older patients with multiple long term co-morbidities and the need for multidisciplinary assessment and rehabilitation rather than a narrow focus on a single organ or illness episode. Both agree that there is a good and growing evidence base for interventions such as comprehensive geriatric assessment or the management of syndromes associated with frailty such as falls, immobility, delirium or incontinence. Both agree that within mainstream medical values and training the necessary skills and attitudes towards older people are lacking and that too many staff are overly biased towards curative treatment of single organ pathology using high tech treatments in younger patients and that generalism in hospital medicine is undervalued. What the argument advanced by Denaro and Mudge lacks is a pragmatic appreciation of how things are rather than how they might ideally like them to be. Firstly, purely age-related admission criteria are rare these days, with geriatricians selecting those with frailty, complexity and disability. More importantly, the aspiration that all staff working with adult patients should have the requisite skills is a noble one, but sadly a triumph of hope over experience. Geriatric syndromes continue to be poorly recognised and managed, attitudes to the care of older people to be poor and the care of older people to have lower perceived status and value that high tech medicine. There is also a gross disparity in research funding and the amount of training in geriatric medicine in both undergraduate and postgraduate curricula does not reflect the fact that 60% of all hospital beds are occupied by older people and that the median age of hospital patients in the UK (and Australia) is aroun 70. Until this imbalance is corrected, we will continue to need a speciality which advocates on behalf of neglected patient groups and conditions. When so few doctors are interested in being general physicians it is hard to see how we will any time soon have a cadre of generalists with good skills in geriatric medicine. And there is no more validity to a specialism based on one organ than there is to a specialism based on the needs of complex frail older people. The last thing older people need is to be passed around between multiple specialists - one for each organ David Oliver Competing interests: None declared |
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Celine M Aranjo, Retired GP New South Wales, 2208, Australia
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No.Because since recently, medical students and other interested GPs are informed BY Geriatricians that there are special needs and treatments in the elderly, and one of these is that common medicines need to be used with caution; another reason is that the elderly nutritional needs also deserve attention---when medications serve to increase nutritional deficiencies e.g.cortico-steroids and osteoporosis which does not always respond to concomitant doses of anti-osteoporosis treatment. Competing interests: None declared |
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Peter Crome, Professor of Geriatric Medicine Keele University Medical School, UHNS, Stoke on Trent ST4 7QG
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Geriatric medicine was established in the UK as a specialty because of the neglect of older people the medical community at that time. Although, of course, things have improved over the last half century it was still necessary for the Department of Health in the UK to make the “routing out of age discrimination” the first standard of its 2001 National Service Framework for Older People. Collaborative working between geriatricians and other specialists has produced great successes, for example, in stroke care and the management of fracture neck of femur. On the other hand the diagnosis, investigation and treatment of patients presenting with the geriatrics giants of falls, intellectual deterioration and incontinence is often completely ignored by generalists in today’s industrial production line hospital where maximising discharge rates to make “profit” can be the order of the day. Our Society accepts that Geriatricians do not have a monopoly of wisdom and enthusiasm when it comes to caring for frail older people and that is why we have opened our membership to all doctors and healthcare workers who share our vision of a health and social care system which treats all older people, especially those who are frail, disabled or with mental health problems with dignity, skill and compassion. Competing interests: President, British Geriatrics Society |
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Manfred Gogol, Head of Geriatric Department Krankenhaus Lindenbrunn, Lindenbrunn 1, Coppenruegge 31863, Germany
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Geriatric medicine is working with a multidimensional assessment and a multidisciplinary approach including the special needs of elderly patients regarding issues of functional impairment, rehabilitation, discharge planning, integrating different sectors of care, e.g. acute, sub -acute and rehabilitation in- and out-patient care, and different settings, e.g. independent and assisted living at home, nursing home, mixed settings including different types of dayclinics and daycare. Besides the fact that other disciplines have yet neglected the necessity of this approach to elderly patients (1) and therefore often not recognised the high vulnerability of elderly patients, not only the frail ones, they also often underestimated the benefits of medical procedures in elderly subpopulations. Under this circumstances it is nice to read that other specialties are now willing to learn from geriatric medicine and will integrate the good experience of multidimensional and multidisciplinary approach to there patients, regardless of age (2). But in a time where general internal medicine have developed in more and more subspecialties and sub-subspecialties, e.g. cardiology and rhythmology, there is the question of the future direction. The ageing populations in the whole world can have only one answer: geriatric medicine is the future of general internal medicine. The general practitioners needs specific knowledge and training in geriatric medicine too, but it is impossible to be the ONE specialist over the whole age span and for all specialties. In the way of arguing against geriatric medicine Denaro and Mudge can also integrate cardiology and other specialties into general medicine. At last: if the special considerations of age and of ageing will not explain the necessity of geriatric medicine than what will happen to pediatrics? 1. Flicker L. Should geriatric medicine remain a specialty? Yes. BMJ 2008;337:a516 2. Denaro CP, Mudge A. Should geriatric medicine remain a specialty? No. BMJ 2008;337:a515 Competing interests: Geriatrician |
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Rodger C Charlton, General Practitioner The Surgery, Marsh Lane, Hampton-in-Arden, Solihull, West Midlands, B92 0BS.
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Two excellent views are provided as to whether ‘geriatric medicine’ should remain a specialty. However, a most important issue has been overlooked and that is the continued use of the word ‘geriatric’. In support of the argument Flicker uses the term "older people" and against the argument Denaro and Mudge make the important point that “health care is a continuum and breaking the journey into arbitrary steps” eg, over 65 is therefore not appropriate. As a GP I would concur that the health needs of older people should be identified and managed optimally, but could a change in terminology be considered from ‘geriatric’? Competing interests: None declared |
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Adam L Gordon, Specialist Registrar in Health Care of Older People Nottingham University Hospitals, Nottingham. UK. NG5 1PB., Adrian G Blundell, and Rowan H Harwood.
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Editor, The debate presented by Denaro, Mudge and Flicker (1,2) surrounding the future of geriatric medicine is a useful introduction for the uninitiated to what is, in reality, a long-running discussion. The question of how old and how frail patients need to be in order to merit our attentions have been debated elsewhere (3). Questions on “the future of geriatric medicine” are de rigueur in specialty interviews. The distinctive perspectives that a geriatrician brings are a comprehensiveness uncommon amongst ‘organ-specialists', attention to disability and discharge planning, and a knowledge of therapeutic intervention at a variety of levels from pathology to environmental modification. It is these very features that make geriatricians attractive as acute and general physicians. The problems of someone with COPD are likely to to stretch beyond respiratory function. If a case lacks the complication of co-morbidity, disability or social disadvantage, it is simply becomes easier to deal with, but at least the relevant questions about complicating factors will have been asked. Geriatrics has made significant headway in recent times. The emergence of sub-specialities grounded in geriatric expertise, often based around multi-professional systems, have provided a major advance for health services. In the UK these include stroke and falls services, orthogeriatrics and others. Geriatricians have been instrumental in developing and delivering the national service framework for the older person, which has been associated with gains in the quality of care for older patients (4,5). We have played an important role, with colleagues in old age psychiatry, in the consultation phase of the national dementia strategy. There are good examples of geriatrician-led nationally co- ordinated clinical governance, in the form of the national stroke sentinel audit (6) and the national audit of continence care (7). Perhaps most importantly we have, at last, gained vocal support for nationally funded high-level research into the challenges which face the ageing population (8). Numerous challenges do remain. As Denaro and Mudge highlight, demographic changes continue to loom large and we are not, as a profession or as a health service, prepared for this. Assessment of disability and approaches to rehabilitation are not well understood by most hospital physicians. It is not that other doctors cannot approach patients as a geriatrician would, and some undoubtedly do, but that many do not. Comprehensive geriatric assessment, far from being widely accepted amongst generalist colleagues in the UK, remains the preserve of geriatricians (and the other allied health professionals they work with). Further, the evidence-base for its application in our own health service and the wider community is complex and further research is required to determine the best models for care (9). Despite Flicker’s enthusiasm, we have not yet arrived at a model of frailty that is sufficiently evidence-based to gain consensus support across the specialty, let alone in the wider profession (10). The quality and extent of undergraduate teaching in geriatrics in the UK remains uncertain (11,12). If, as Denaro and Mudge suggest, generalists should all be competent in the practice of geriatrics, then this is a source of considerable concern. A significant worry is physicians who think they can do everything a geriatrician does, but in reality cannot or do not. The exclusion of geriatricians from intermediate care rehabilitation services in some parts of the UK, on the basis that general practitioners had sufficient skills, perhaps being a notable example. Age Concern and the Alzheimer’s Society continue to campaign for increased engagement between older patients and the medical profession (13,14). This should remind us, as a profession, of our continued failure to fully get to grips with the ageing agenda; geriatricians have much to offer here. We must lead the research agenda in ageing, push for evidenced-based treatment of older patients and campaign for the delivery of quality teaching in ageing and geriatric medicine. Most importantly, we must use our unique insight into older patients and the problems they face to advocate for ever more responsive services. Geriatrics is the largest medical specialty in the United Kingdom and as such is necessarily a broad church. In such a heterogeneous group the potential for loss of focus and direction is ever-present. Maybe the biggest problem has been explaining and selling the added value that a geriatrician brings, and many would argue that the message has not been widely heard in recent years. The discussion surrounding our role and future as a specialty is essential in continually re-focussing our attentions on the changing priorities of the ageing population. This is ultimately to the benefit of our patients so long as their interests remain at the heart of the conversation. Let the debate continue. References 1 Denaro, C P., Mudge, A. Should geriatric medicine remain a specialty? No. British Medical Journal 2008;337:a515 2 Flicker, L. Should geriatric medicine remain a specialty? Yes. BMJ 2008;337:a516 3 Powel, C. Whither geriatrics? Do we need another Marjory Warren? Age Ageing 2007;36:607-610 4 Morris, J., Beaumont, D., Oliver, D. Decent health care for older people. BMJ 2006;332(7551):1166-1168 5 Manthorpe, J., Clough, R., Cornes, M., Bright, L., Moriarty, J., Iliffe, S., and OPRSI (Older People Researching Social Issues). Four years on: The impact of the National Service Framework for Older People on the experiences, expectations and views of older people. Age Ageing 2007;36:501-507 6 Rudd, A., Hoffman, A., Irwin, P., Lowe, D., Pearson, M. Stroke Unit Care and Outcome: Results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland). Stroke 2005;36(1):103-106 7 Wagg, A., Potter, J., Peel, P., et al. National audit of continence care for older people: management of urinary incontinence. Age Ageing 2008;37(1):39-44 8 Medical Research Council. Research in focus – Ageing. Available at: http://ageing.oxfordjournals.org/cgi/content/citation/36/6/607 [Accessed July 13, 2008] 9 Ellis, G., Langhorne, P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2005;71(1):45-59 10 Martin, FC., Brighton, P. Frailty: different tools for different purposes? Age Ageing 2008;37(2):129-131 11 Lally, F., Crome, P. Undergraduate training in geriatric medicine: getting it right. Age Ageing 2007;36(4):366-368 12 Gordon, AL., Blundell, AG., Gladman, JRF., Masud, T. Undergraduate education in geriatrics within the United Kingdom. Age Ageing 2007;36(6):705 13 Age Concern. NHS failing older people needing continuing care - local black spots exposed (11.04.08). Available at: http://www.ageconcern.org.uk/AgeConcern/11898975B217420A92EE92F9D24A465E.asp [Accessed July 13, 2008] 14 Alzheimer’s Society. Doctors and patients should work together to make decisions about treatment says new GMC guidance. Available at: http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=81 [Accessed July 13, 2008] Competing interests: None declared |
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Gerard J. Ligthart, Geriatrician in community practice Leiden, The Netherlands
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Denaro and Mudge in fact make the case FOR geriatric medicine by describing the ideal health services for the elderly. Unfortunately, their geriatric utopia is not a reality anywhere in the world. Elderly patients are often still being mistreated in our high-speeded and narrow-focused health care systems. The greatest danger is not only organ specialisation but also increasingly disease-focusing. The practice of medicine can roughly be split into three periods (and I simplify for clarity): first the 'Albert Schweizer' period: the doctor is the center of the medical endeavour: when he leaves Lambarene the whole system disappears with him. We are now in the second period: the disease is the central entity: diabetes clinics, heart failure unit, proctology group but also memory clinic. Wrong and even dangourous for the elderly patient in need of all these clinics simultaneously. We now have to proceed the the final period: the patient really is in the center of our concerns. What are the needs of this particular patient, young or old? The director of this deadly serious play must be a maximally committed and competent generalist. For the elderly this generalist must have full knowledge of the age-dependent changes in the body, the mind, and of the complex interaction with the surroundings in broadest sense. Organ specialists are invaluable to help the generalist to provide optimal care for specific diseases. On the other hand, a carousel of organ specialists is a real danger to a complex, frail, confused elderly patient. So happily, Denaro and Mudge agree with me that every specialist (not fully excluding the pediatrician or even the neonatologist!) must have knowledge of gerontology and geriatrics. Patient-centeredness must be the lead of multidisciplinarity, and not the other way round. That is the main lesson the practice of 25 of rewarding years of geriatric medicine has learnt me. And, indeed, you need much youthful recklessness to engage in geriatric medicine! With thanks to Michiel Noordzy, pediatric psychiatrist, for the Albert Schweizer model. 1. Flicker L.Should geriatric medicine remain a specialty? Yes. BMJ 2008; 337: a516, doi: 10.1136/bmj.39538.481273.AD 2. Denaro CP. Mudge A. Should geriatric medicine remain a specialty? No. BMJ 2008; 337 :a515, doi: 10.1136/bmj.39533.696076.AD Competing interests: Working in health care for seniors since 25 years |
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Sirish Vasireddy, ST3,Geriatric medicine King's Mill Hospital.NG17 4JL, Anne-Louise Bridge and Jeremy Snape
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Geriatric medicine should remain a specialty.Whilst we agree that older people with single pathology should be managed by the appropriate specialist,and that it is illogical to practice age related geriatrics,we feel that frail patients with multiple medical problems(often who have limited life expectancy)are patients best managed by geriatricians.Demographically this group is becoming larger. Furthermore there is much to do for these patients,not only relating to appropriate assessment and management of their complex problems but also in trying to improve attitudes. Some clinicians continue to use pejorative terms such as "bed blocker,"old crocks,"and "crumblies"when describing older patients,demonstrating the inveterate ageism which still occurs in hospitals.This group of doctors may also,following a less than thorough assessment of such patients,arrive at a diagnosis of "acopia"or"social admission."Medical trainees need role models and mentors who demonstrate a more logical,comprehensive and humane approach to older patients.Geriatricians who are willing and enthusiastic to care for this patient group are best placed to take on this role. The specialty is evolving in Britain.Geriatricians are developing special interests in areas such as acute care,falls,intermediate care,incontinence,dementia,stroke,nutrition,ethics and other fields,leading to growth in research.American and Australian hospitals may be creating generalists but in UK there is increasing specialisation in medicine and physicians in care of older people are these days the only true remaining general physicians. Denaro states that geriatricians are responsible for the development of the principles of multidisciplinary(MD)care for complex chronic disease and that this model has been effectively disseminated and integrated into other specialties.We agree that this is the case in some areas,but it is by no means universal.Moreover,there are areas where its employment,led by geriatricians,are reaping new benefits eg."at the front door"in acute medical units(there are examples of this approach reducing admissions and facilitating early discharges).Denaro also states that MD teams do not necessarily require medical leadership.In our experience without strong medical input these teams function much less well. In UK,therefore,the specialty of geriatric medicine continues to evolve.It remains a model for geriatric medicine in the rest of the world,including the emerging nations.Geriatricians remain as role models for young doctors and trainees in their upholdig of positive and robust advocacy for older people.To abandon the specialty woul be a retrograde step. Competing interests: None declared |
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Jeffrey TJ Rowland, General Physician and Geriatrician The Prince Charles Hospital, Brisbane 4032
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All seem to agree that geriatric medicine has been of benefit: That the geriatricians have instituted a mode of care which incorporates both holistic principles and multidisciplinary teamwork with a strong influence from the nursing and allied health members. Drs Denaro and Mudge seem to have been pleased to adopt these principles in their general medical practice to assist them in the ever aging clientele in our hospitals: A patient population peppered with chronic illness and requiring a whole of system team approach. The adoption of these principles by other physicians seems to be reason enough to say goodbye to the specialty as though it offers nothing else: Much in the same way that we might rid ourselves of neurologists with the advent of MRI (Magnetic Resonance Imaging). I would argue that geriatricians offer much more than just team managers. Even more, I would argue that they offer all that a general physician does plus the ability to manage a patient across the continuum of care. They are trained in care from preventative through acute to subacute and community and on into residential. They are trained in all the physician systems. I would argue that they stand alone at working across the whole system of healthcare. I would like to see the argument as to why we should not rid ourselves of generalists and replace them with geriatricians. Competing interests: Executive member of the Australian and New Zealand Society for Geriatric Medicine |
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Rowan H Harwood, consultant stroke physician Nottingham NG5 1PB
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I practice as a stroke physician, but argue that I can only do that having started as a geriatrician. Years ago I recall a case discussion in a throwaway cardiology journal featuring the management of a middle aged East African Asian man with ischaemic heart disease and intractible breathlessness. Doubtless the editor wanted a discourse on the value of coronary angiography or the use of the then new drugs such as flosequinan or milrinone. The discussant was John Hampton, a cardiologist who knew his general medicine inside out. His first line was 'First I'd do a chest X-ray to exclude TB...' You can't manage heart failure without a grounding in respiratory medicine. You can't manage stroke without knowing geriatrics. In the past subspecialties grew out of their parent specialty. Perhaps the mistake now (abetted by modern high-speed training) is to try to become a sub-speciaslist first without doing your time as a generalist. It doesn't work. Competing interests: None declared |
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Hammad Akram, Research Staff Oklahoma Medical Research Foundation
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Geriatric medicine should remain a specialty: YES If we consider the current scenario of US, the concern in USA is the people >85 years of ages as they are increasing rapidly over the last decade. According to statistics of Americas by the year 2010, the growth rate of the older population will be three and-a-half times as high as that of the total population, and the growth of the 75-and-over segment will be accelerating. So there will be a major concern of health care of these populations in near future. The field of geriatric medicine can play an important role in dealing with multiple chronic diseases associated with aging by early diagnosis and prevention, managment and rehabilitation. Hammad Akram MD, MPH Competing interests: None declared |
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Feroz M Shah, FY2 Manchester Royal Infirmary
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We are heading towards more specialised services and medics are now training early on into a specific field. Which is good for patient care as they get optimum treatment. But bad for the medical professionals as they lose many skills and tend to know very little outside their speciality. So we are producing more specialised expert doctors not broad-spectrum general doctors. In this respect geriatrics should go. We cannot have two types of health care for different age groups. Competing interests: None declared |
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Roberto S Salinas Durán, Internist and Geriatrician Centro Médico San Felipe Gregorio Escobedo 660 Torre 1 Cons. 201 Jesus María Lima Perú
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I was already an Internist before I became a Geriatrician. It is amazing how Geriatrics must cross the same difficult ways to develop, despite the place or time in which it begins. When I started working in the Geriatric service of a military hospital in Lima Peru, the main problem I had was the jealousy and opposition of my internist colleagues. Some of them where sincere and openly claimed that geriaticians were "stealing their patients". But, is that true? Certainly not. First, because most of the patients that the internists lose visit other specialties. Second, because patients "stolen" by geriatricians were neglected by internists for a long time in the past; good examples are patients with dementia or cronically disabled. And finally, because Geriatric Medicine is not the internal medicine of the aged the same way as pediatrics is not the internal medicine of children. Geriatrics is a different specialty. Geriatrics has contributed to medicine in long underecognized ways. To give some examples, focus on quality of life, which is so in vogue today, or multidisciplinary teams, "discovered" recently by other specialties such as endocrinology or psychiatry. Older people are the main users of health services and in the future this will increase. It is clear that only a minority of patients seeking for a doctor will be under 65 - 70 years old. So, how many internists will be needed in the future for those between 14 and 64 who get sick? Probably only a few. That is really happening in most places. Please render hospitals to the Geriatricians. Roberto S. Salinas
Competing interests: None declared |
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