Email your comments

I think the geriatric medicine buzzword of 2006 has got to be “Dignity”. So what is “dignity” anyway?

Ian Philp said it, Jackie Morris promotes it, Adrian Wagg describes the lack of it at ablution time, but how do we know when we’ve got it? In a quiet moment, David Oliver and I were playing around with the idea, and prompted by the current BBC programme searching for a new Maria to play in the West End production of “A Sound of Music”, I came up with a list of “My Least favourite things”. See what you think and forgive the colloquial language which is designed to promote easy reading, rather than showing a lack of respect.

• Commoding behind screens in open wards;
• Open visiting at ward round time leading to loss of confidentiality;
• Nightdresses or smocks with splits up the back allowing mooning;
• Poorly closing or shrunken ward curtains allowing more mooning;
• Pyjama trousers that don’t fit or fall down allowing flashing;
• Nurses pointing out publicly that mooning or flashing is occurring;
• Patients being transferred to bathrooms suspended in midair from hoists without a blanket over the legs [like a demolition ball];
• Patients of different genders in adjacent beds on Medical Assessment Unit;
• Boarding of frail and vulnerable older people from acute wards to make way for new admissions;
• Continence aids that look like nappies worn without trouser bottoms;
• Forced discharges to care homes without multi-professional assessment;
• Judgemental terminologies e.g. bed blocker, social admission, acopia, demented, old dear, pleasantly confused, senile;
• Senility as cause of death on certificates;
• Denial of active treatment because DNAR order is in place on somebody who is not dying immediately;
• Catheter bags trailing on the floor.

I am sure you can think of many more – if so, send them in and we will add them to the list of Indignity Descriptors.

Luminaries
We were delighted at the office recently to receive two letters from senior members of the Society which we have reprinted for you on the letters page. James Leeming kindly wrote concerning our piece on relations with the pharmaceutical industry, and Professor John Brocklehurst also wrote in with some fascinating information on the BGS strapline. The competition is still running with several responses received, so we hope to announce the winner in January.

Welcome to the New President Elect
On behalf of the Editorial team, I want to congratulate both Graham Mulley and Doug MacMahon for their contributions to the extremely tight Presidential election held recently. The closeness of the result reflects the esteem in which both candidates are held by members of the Society. We look forward to hearing Graham’s perception of the way forward during his tenure of the Chain.

Service Implications of Modernising Medical Careers – Icebergs ahead
I also wanted, in this issue to reflect on the subject of Modernising Medical careers and its implications. We are a mere twelve months away from the implementation of what promises to be the biggest shake up in the way medical services are structured and delivered for generations, yet I am struck by the general lack of awareness and indeed concern shown by many colleagues regarding the implications of the changes. Although the first phase, the establishment of the Foundation programme, has been very successful by all accounts, greater upheaval is possible from next August when SHO posts will disappear, to be replaced by a smaller number of run through grades and an uncertain number of Fixed term speciality training appointments, all applied for nationally and allocated by Regional speciality training schools. The question is, can current rotas be maintained with the reallocation of gradings?

Many trusts have achieved European working time directive compliance by establishing Junior and Senior clinical fellow posts. What happens to these posts? Junior, Senior and Teaching fellow posts may need to be converted to new National Training numbers or Career grade posts.

Now this latter point brings us to the nub of the issue. One of the objectives of Modernising Medical Careers is that the bulk of care will be delivered by “trained Doctors”. As far as I can make out this means people on the Specialist register, presumably consultants. Those who choose to be trainers will be undertaking much more educational and clinical supervision, which will be more costly for Trusts. Now, my question is, and forgive me if I missed it, where and when was this fundamental change of role from leaders of care delivery to deliverers of care discussed with the profession? This has very profound consequences for geriatricians, ranging from loss of autonomy, to narrowing choice over annual or study leave and opportunity to attend committee meetings. There will be more work in the wards or MAU directly delivering care – even at night. Will we be able to staff rehabilitation units if we do not have foundation or speciality training posts in these areas? For all the benefits in terms of structured training which will arise, the patients will still need to be treated and wards staffed. My advice is, be prepared and seek out your local Modernising Medical Careers implantation group to calculate the effects on service from next August.

Final Word-Husbandry?
I have waited to become established in this role before attempting to relate this true but anonymised story. I hope the Eminent figure referred to will not take offence.

Some time ago I attended a conference, where a distinguished speaker from Europe was addressing positive models of Ageing. He described how his uncle, now in his nineties lived in an independent community unit with six ladies of similar vintage. The gentleman concerned was by some way the fittest of the group and supported the others. The speaker had, I think, intended to say on this basis, that it was his uncle’s job to tuck the ladies in at night, but it came out…”it is my uncle’s job every night to cover all six ladies before retiring to bed himself.” A truly impressive feat, I am sure you will agree, and requiring no further words from me.

Dave Beaumont