One of the privileges of being President of the BGS is seeing a draft of the Newsletter before I write my column. I therefore have the opportunity to comment on three contributions in this issue.

The first is the reprint of the article from The Times, ‘Young Docs for Old’ (for copyright reasons, not reproduced in this online version of the Newsletter). The second is that of Dr Mark Barber on why he went into research. The future of our specialty depends on attracting some of the best young doctors into it and it is the responsibility of all of us to encourage recruitment into the specialty. Fortunately, as I meet members across the country, I have been able to observe that we are very successful in this. However, the numbers are still not what we need, partly because of the continuing expansion of our specialty and partly because of an overall shortage of doctors. We, therefore, have to strengthen our efforts.

Many young doctors now select geriatric medicine as their first choice of specialty. This is often because they have had a good experience of our specialty when they have been students or junior doctors. The value of the role model is well described by Dr Sally Briggs in the article from The Times. Students and junior doctors are encouraged to think of geriatric medicine as a career by seeing their peers of only a few years seniority entering our specialty. In the last Newsletter I mentioned some of the reasons why education in geriatric medicine is so important. We should not underestimate the importance of education as a means of recruitment and we should not be reluctant to use it for that purpose. Many doctors choose their specialty because of their experience as students, when they are given a positive message by teachers they respect and when their interest is stimulated. Medical students are very sensitive to the doctor/patient relationship and they are impressed by doctors who treat their patients with respect and are respected by them. This is an area where our specialty should score well. Other advantages quoted by doctors joining our specialty are, liking old people; the intellectual challenges of dealing with multi system diseases combined with psychological and social problems; more patient contact than in some of the more technologically based specialties; and the fact that doctors are valued by older patients. It is vital that we demonstrate these features to students and junior doctors and do not lose them from our specialty.

Strong academic base
Dr Barber’s column on research also has useful insights. As I have mentioned before, it is vital that our specialty has a strong academic and research base. The opportunities for research in ageing, age-related conditions and health care of older people are considerable. The new opportunities for clinical research which are opening up in the United Kingdom should not be missed, and it is no accident that most of the conditions which are being given the top priority in the new UK Clinical Research Collaboration are common in older people, including stroke and dementia.

I hope that our vision for our specialty includes a strong group of young doctors with excellent clinical skills, a broad range of interests and, for at least some, a record of and continuing interest in research. It may seem a lot to ask but we must not set our sights too low.

The Future
David Black’s report of the England Council includes an interesting summary of the document, ‘The Challenge of Consultant Geriatric Medicine in England’. I am sure that the remainder of the United Kingdom would support all of these recommendations. I have recently heard two talks on the future of health care, which paint a very different picture from what we have now. Our acute hospitals are built around technology which until now has resulted in centralisation of acute care in large hospitals. The further development of technology in the current century will tend to reverse this trend as with improved information and communication technology, and with miniaturisation of equipment, technology will move closer to the patient and out of the hospital. One of the speakers speculated on what could be removed from the District General Hospital and there was little remaining. Most specialist opinions currently given in outpatient departments could be provided in community medical centres; much diagnostic work could be undertaken in primary care; and most elective procedures could be moved to ambulatory care centres which need not be near DGH sites. Patients would not wait in hospital beds for diagnostic procedures. What would be left in hospital would be acutely ill patients undergoing acute care. In future much of what is currently delivered in hospital would take place in the community and instead of large DGHs there would be multiple smaller units with 30-40 doctors working in a community setting. Alongside this there would be a very different system of primary care, with nurses undertaking much of the general practitioners’ current workload, and a blurring of the division between general practice and many of the current hospital specialties. This of course is speculation but it does not seem too far fetched. An urgent task for the medical profession is to define the role of the doctor in an increasingly skilled multi-disciplinary team. It is important that as well as setting out the standards needed for current delivery of the best possible healthcare to older people, we should be thinking innovatively of how services should develop in the future.

Bob Stout