Future directions for geriatric medicine

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7239.936/a (Published 01 April 2000) Cite this as: BMJ 2000;320:936

Red rag but no bull?

  1. Adrian Turrell, senior research fellow (adrian.turrell{at}nottingham.ac.uk)
  1. Trent Institute for Health Services Research, Regent Court, Sheffield S1 4DA
  2. Royal Wolverhampton Hospital, Wolverhampton WV10 OQP

    EDITOR—I waited patiently for the response to Young and Philp's editorial on future directions for geriatric medicine,1 imagining that the BMJ's postbag might be swollen by responses to their speculations.

    Why did this not seem to be so? Was it that the authors so perfectly put into words the feelings, thoughts, and hopes of their colleagues, such that there was no tinge of red in the rag being waved or no bull in the ring to be provoked? Unlike me, no one in the crowd seemed to have been expecting a contest.

    Or perhaps the bull couldn't be bothered to turn up, and the crowd, anticipating a no-show, didn't turn up either? (If truth be known the bull had died and been reincarnated as an ostrich.)

    So, perhaps, I can happily conclude that all geriatricians have no qualms about leaving the hallowed corridors of familiar district general and teaching hospitals? That the authors raise no issues for their colleagues about priorities, managing workload, payments for domiciliary visits, marching repeatedly across the threshold of nursing homes, delivering “joined-up” care with general practitioners, recapturing rehabilitation skills that have atrophied in the acute environment?

    Perhaps I feel a touch of déjà vu, remembering the consummate ease with which the recommendations of the Royal Commission on Long Term Care were shuffled into obscurity because the needs and plight of the older people fail to capture the hearts and minds of the public and hence those with political power or influence.2

    Perhaps I should retire as a frustrated bull, admittedly on the outside of the ring, and be prescribed some good old fashioned reality orientation or electroconvulsive therapy?

    • Where there is no vision, the people perish

    • Proverbs 29:18

    • We have already perished; for there is no passion Anonymous


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    More geriatricians will be needed to satisfy increasing demand in community

    1. Dominic D'Costa, consultant physician in the care of the elderly (domdcosta{at}compuserve.com)
    1. Trent Institute for Health Services Research, Regent Court, Sheffield S1 4DA
    2. Royal Wolverhampton Hospital, Wolverhampton WV10 OQP

      EDITOR—In their editorial Young and Philp controversially suggest that geriatricians move with their patients into the community.1 By so doing, we as geriatricians risk foresaking all that has been achieved in the past 50 years on equal access to acute medical care for elderly patients. Even now, inequalities may still exist in acute care—for example, some coronary care units have age restrictions despite the fact that elderly people derive greater benefit from thrombolysis as their risk is greater. Furthermore, with the number of elderly people set to increase, a rise in the demand for acute services—and hence the services of elderly care physicians—is inevitable.

      The demand for increasing participation in community services has in fact started. In our district we have been able to satisfy it by appointing two new community geriatricians. The solution therefore is not solely that geriatricians should move with their patients into the community but that more geriatricians need to be appointed. If, for example, the demand for endoscopy rises, gastroenterologists are not asked to move into endoscopy suites: more of them are appointed.


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