What does a geriatrician do? It is easy for most specialists to define themselves: a cardiologist looks after the heart, a respiratory physician the chest. But for a geriatrician it can be surprisingly difficult. Are we simply general physicians for older people, or do we have a more specialist skill?

This has recently been a cause for (occasionally heated) debate in our department. We are in the process of making plans to merge two large departments of medicine for the elderly from opposite sides of our city. On one side there is a specific cut-off age for acute admissions, while the other has a “needs related” policy. At first glance the second would seem to be preferable: older patients with a “single organ” problem are sent to the relevant specialty, while patients with more complex needs are admitted under our care. But the problem with this is that it is open to abuse by our specialty colleagues, and referrals are all one way in our …