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Recently, members of the UK Management Committee had the opportunity to view early drafts of the report from the RCP (London) Task Force on Acute Medicine.

Although this is clearly work in progress and it will be some time before the final report is available, it is fair to say the content caused considerable discussion. The Report as I see, it seeks to define the role and remit of the emerging speciality of Acute Medicine within the big picture of reforming Emergency and Urgent care and provide guidance on the site and functioning of Acute Medical units and the links with Critical care and Emergency medicine [Accident and Emergency] departments. One key theme revolves round the interaction with other medical specialities as well as the training and supervision of trainees in Acute medicine, and another was the recognition of the concept of “competent decision makers“ presumably at ST3 level and upwards and “senior decision makers” presumably consultants or other Career grade doctors working on the shop floor.

Now it is fair to say the first draft drew some stinging criticism from Society members, quite rightly in my view because it did not acknowledge the particular challenges presented by frail older people presenting in increasing numbers with functional problems including falls, delirium and reduced self care to Emergency services, nor did it highlight any training needs with regard to assessment of frail older people. To be fair, once our President with a masterly piece of under-statement had reflected back these views, the next draft appeared with two new pages specifically concerning the needs of older people.

I continue with a sense of unease about where we are going as a speciality with this question of dealing with emergency admissions. For some time we as geriatricians have argued that too much time has been spent doing Acute Medicine to the detriment of appropriate care of older people. Other specialities have argued the same and this has led to some specialities reducing their commitment to the take, so the development of a new speciality to manage the rising numbers of acute admissions, triaging appropriate cases to speciality wards and turning around others in short stay areas, seems a neat solution, especially as some of our members are undertaking these roles as Acute Physicians. However, in the debates I have with colleagues, I feel we are in danger of giving out mixed messages. There is a reluctance by many to become involved with providing specialist input into Acute Medical Units, partly because of the amount of work involved on top of current responsibilities, and partly because of shortage of numbers. Secondly, it isn’t just a question of providing advice and support to acute physicians, we will be expected to assess frail older people and take responsibility for their onward management whether in hospital or the community. Thirdly, some argue that designated older persons assessment areas are already in existence and this is a step backward but it is really hard in this era of “lean” thinking to make a case for duplicating facilities. It may not be a popular view, but the reality is the Giants of Geriatrics are now presenting at Accident and Emergency and Acute Medical Units and we need to be in there making sure comprehensive assessment is being done by us. We will not be credible at the Royal College if we complain loud and long that the needs of frail older people in acute areas are being ignored, then opt out of addressing them ourselves. Acute Medical units are set to become Dragonboats with large numbers of organ specialists paddling furiously against the tide with acute physician colleagues.

New Members
One of the great changes over the last few years has been the diversification of membership of the Society. I am really pleased to see increasing numbers of Nurse Specialists joining and establishing the special interest group. In the latest batch of applications for membership, I was delighted to see a family of 4 or 5 applications from a group of Nurse and speciality managers from Aberdeen, keen to develop further knowledge of geriatric medicine. You are MOST welcome and please make yourself known at the BGS stand in Harrogate or Glasgow if you are attending.

Reflections
A number of you may be aware that this will be my final editorial as Secretary of the Society and Editor of this Newsletter. I would like to say how fortunate the Society is to have such excellent staff at Marjory Warren House, who have been unfailing in their help and support to me. I would like to thank Alex, Recia, Jo and Susan and of course, the pseudo-Geordie Sarah, for all their help, as well as the retiring Chair of the Policy Committeee who has generously (if unwittingly) supplied items for the ”Final Word”. I still can’t believe that some time ago she fell over and fractured her elbow returning from an Orthogeriatric ward round, but there you go.
On a serious note, I have not mentioned previously my most striking reflection of this period, namely arriving at Kings Cross at 9.25am on 7 July 2005 to attend a meeting at Marjory Warren House, and being immediately evacuated from the station. As we left there was a dull thud as the Tavistock Square bomb went off close by, followed by the realisation that I had stepped into a war zone. My memories are of walking to the office along silent streets, free of traffic but populated by thousands of people streaming across London, the air screaming with sirens. At the office all the team were already there and planning the next move, along with Jerry Playfer who had also just arrived. We ate the sandwiches intended for UKMC and felt helpless. Recia booked some hotel rooms but by mid afternoon we had planned our various escape routes. Recia had found out we could get a train from Finchley Park so the two of us hiked the four miles to the station, queued for a while and got a train to Welwyn, then a change to Peterborough, and from there a train to Newcastle arriving around midnight. We were the lucky ones.

Egobusters
In contrast to Graham Mulley’s anecdote last month, I can tell you of this incident which happened only last week. Our acute ward round was repeatedly punctuated by a patient with hyperactive delirium joining and rejoining the ward round to ask when she could leave to meet the kids from school. Having reassured her in the kindest way possible, I pulled the screens around the next patient and introduced myself, ”Hello, I’m Dr Beaumont…” and paused. From the other side of the screens, I heard the retort, “God, he’s s**t isn’t he?”

Final, final Word
I recently heard tell of a young and somewhat inappropriate new Matron at a local care home, who on the first day introduced herself to three male residents in the day room by asking, “Now who’d like some Supersex?” After two rejections from frightened looking gentlemen, she was pleased to see the eyes of the third resident light up with anticipation, only to have him declare, “Thanks love, I’’ll have the soup”.
Now this story illustrates two things; firstly that tastes change as we get older, but secondly, that times also change, which means that it is now time for me to hand over stewardship of this publication to David Oliver to whom I extend my best wishes for his tenure of the post. Thanks to all of you who have taken the trouble to write in and for the many kind words you have exchanged. Above all, thanks for listening these last 2 years. H’away the lads [and lasses].

David Beaumont

BGS Newsletter, October 2007
Issue 13 ISSN 1748-6343 13