Head To Head

Should geriatric medicine remain a specialty? Yes

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.39538.481273.AD (Published 30 June 2008) Cite this as: BMJ 2008;337:a516
  1. Leon Flicker, director
  1. 1Western Australian Centre for Health and Ageing, School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, Perth, Australia 6001
  1. leonflic{at}cyllene.uwa.edu.au

    The development of geriatricshas greatly improved care for older people. Leon Flicker believesspecialist care remains important for this vulnerable group,butC P Denaro and A Mudge (doi: 10.1136/bmj.39533.696076.AD) argue that age divisions are no longer relevant

    How are specialties of internal medicine determined? Mostly by a focus on individual organs, which reflect the colocation of cellular systems, which have been so arranged by some chance survival advantage common to all mammals. Even within a specific “organology,” individual specialists have a distinct range of expertise based on patients’ and practitioners’ interests, such as interventional versus non-interventional cardiologists. The advantage of subspecialisation, no matter how determined, is clear—it allows the practitioner to focus on specific knowledge, skills, and attitudes that can achieve better patient outcomes. However, for most subspecialties of internal medicine, the evidence for benefit on patient outcomes is lacking. Fortunately, this is not the case for geriatric medicine, and in fact if the specialty of geriatric medicine did not exist, we would be obliged to invent it.

    Evidence of benefit

    The …

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