The future of geriatric medicine
SIR—That the paying public is not as embarrassed by Geriatric Medicine as Metz and Labrooy [1] is shown by the rapid increase in private practice in the specialty. Twenty-five years ago, there were a handful of geriatricians with significant private practices in central London. Now every private hospital throughout the affluent areas of England has access to geriatricians with substantial private caseloads.Their comments, however, should not be ignored, although there is another future for the specialty in the environment that they describe. The development in the UK of most physicians as protocol-driven organ specialists leaves space for the continuation of the specialty of General Medicine. Current physicians accredited in ‘General (Internal) Medicine’ are good at managing medical emergencies but have little experience in less acute disease. Patients of all ages with non-specific symptoms, mixed medical and psychiatric problems and multi-system disorder may have problems finding an appropriate specialist. Older people do not always benefit from care driven by protocols worked out on younger people [2].
The General Physician of the past had little or no knowledge of the most important part of General Medicine, Geriatric Medicine. The public needs a new generation of General Physicians, most of whose training and practice is in what we, today, call Geriatric Medicine but with wider knowledge and experience to deal with general patients of all ages. Many of my General Practitioner colleagues tell me that they are waiting for some of their patients to get older so I can see them. As the late R. E. Irvine (the founder of orthogeriatrics) used to put it, ‘What is good for older people is good for younger people but what is good for younger people is not always good for older people.’
Department of Medicine for Elderly People, Whipps Cross University Hospital, London E11 1NR, UK Email: kalman.kafetz{at}whippsx.nhs.uk
References
- Metz DH, Labrooy SJ. The future of geriatric medicine in an era of patient choice. Age Ageing 2005; 34: 553–5.
[Free Full Text] - Tinnetti ME, Bogandus ST Jr, Agostin JV. Potential pitfalls of disease specific guidelines for patients with multiple conditions. N Engl J Med 2004; 351: 2870–4.
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