Intended for healthcare professionals

Rapid response to:

Analysis Essay

Reform reform: an essay by John Oldham

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6716 (Published 20 November 2013) Cite this as: BMJ 2013;347:f6716

Rapid Response:

Re: Reform reform: an essay by John Oldham

This essay contains much sense and wry observation. However, having described the epidemiolgical transition, he asserts that the problem with the current system is single organ specialists.

Has he never heard of geriatricians? Geriatric Medicine is the second biggest hospital specialty (after anaesthetics). Geriatricians are archetypcal generalists: 'Jack of all trades and master of one' according to Graham Mulley. Historically community orientated, in recent years have been much diverted to managing the medical take (almost all are dual trained in internal medicine), but of late are recolonising community roles. As a geriatrician I both depend on and appreciate the opinions of my more narrowly focussed colleagues when I need them.

Prof Olham is not alone. The RCP Future Hospital Commission (FHC) in its call for more generalists also failed to mention geriatricians.

Pof Oldhams claim that research is a) not needed b) a problem c) concentrated on single organs is bizzare. What about health services research, public health, realist evaluation? This is most of what NIHR does. The failure to evaluate policies rigorously has many times led to us being none the wiser as to whether they actually worked or not; 'more pilots than British Airways' has become the real issue

Competing interests: No competing interests

24 November 2013
ROWAN H ROWAN H HARWOOD
Consultant geriatrican
Nottingham University Hospitals NHST
QMC Nottingham NG7 2UH