Elderly Surgical Patients: The Perspective of Specialist Registrars in General Surgery and Urology
Editor
Dr Herd should be congratulated for a succinct and erudite article.
As higher trainees in surgery, we regularly run a surgical firm at ground
level and of course in our elective and emergency practice come across
many elderly patients.
Physicians with an interest in the care of the elderly patient have
defined competencies and areas of clinical interest and we believe the
call for one size fits all cover of elderly surgical patients demeans the
specialist role of these highly trained individuals.
The NCEPOD report highlights deficiencies in the assessment of vital
signs, recognition and management of nutritional deficit, fluid management
and assessment of pain. In the modern era, this is unacceptable and should
be addressed urgently but we suggest that this can be managed by educated
and motivated surgeons. It is interesting to note that in the 2010 JCST
Syllabus for General Surgery there is no specific mention of competency in
the management of the elderly surgical patient. Is this something that the
surgical community needs to address?
Our plea is that whilst we are capable of performing operations, we
have received general clinical training as undergraduates and
postgraduates arming us with skills to deal with the elderly population.
We are able to take a history, perform an examination and formulate a
diagnosis and management plan. Relegating us to technicians without the
responsibility to ensure the patients recover will ironically diminish the
holistic nature of surgical practice.
There are occasions where there is diagnostic or management
uncertainty as in all areas of medicine and this is very much where the
multi-disciplinary team shines as experienced primarily from our
perspective in cancer and vascular surgery. It would be wonderful to have
the option to seek specialist advice from an elderly care physician in the
'A-level' cases and perhaps we may have a role to play in the multi-
disciplinary teams of elderly care wards?
Yours sincerely
Mr Rahul Velineni MBBS BSc MRCSEd
Mr Jaspal S Phull MbChB MRCS
Mr Vivek Gupta MbChB FRCS(Gen)
Competing interests:
RV and VG are Specialist Registrars in General Surgery in a South Wales DGH and JP is a Specialist Registar in Urology at the same institution.
Rapid Response:
Elderly Surgical Patients: The Perspective of Specialist Registrars in General Surgery and Urology
Editor
Dr Herd should be congratulated for a succinct and erudite article.
As higher trainees in surgery, we regularly run a surgical firm at ground
level and of course in our elective and emergency practice come across
many elderly patients.
Physicians with an interest in the care of the elderly patient have
defined competencies and areas of clinical interest and we believe the
call for one size fits all cover of elderly surgical patients demeans the
specialist role of these highly trained individuals.
The NCEPOD report highlights deficiencies in the assessment of vital
signs, recognition and management of nutritional deficit, fluid management
and assessment of pain. In the modern era, this is unacceptable and should
be addressed urgently but we suggest that this can be managed by educated
and motivated surgeons. It is interesting to note that in the 2010 JCST
Syllabus for General Surgery there is no specific mention of competency in
the management of the elderly surgical patient. Is this something that the
surgical community needs to address?
Our plea is that whilst we are capable of performing operations, we
have received general clinical training as undergraduates and
postgraduates arming us with skills to deal with the elderly population.
We are able to take a history, perform an examination and formulate a
diagnosis and management plan. Relegating us to technicians without the
responsibility to ensure the patients recover will ironically diminish the
holistic nature of surgical practice.
There are occasions where there is diagnostic or management
uncertainty as in all areas of medicine and this is very much where the
multi-disciplinary team shines as experienced primarily from our
perspective in cancer and vascular surgery. It would be wonderful to have
the option to seek specialist advice from an elderly care physician in the
'A-level' cases and perhaps we may have a role to play in the multi-
disciplinary teams of elderly care wards?
Yours sincerely
Mr Rahul Velineni MBBS BSc MRCSEd
Mr Jaspal S Phull MbChB MRCS
Mr Vivek Gupta MbChB FRCS(Gen)
Competing interests: RV and VG are Specialist Registrars in General Surgery in a South Wales DGH and JP is a Specialist Registar in Urology at the same institution.