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In May, doctors who had been successful in passing the PACES examination were invited to the Royal College of Physicians in London to receive their diplomas from the President and to celebrate their success.

The College recognises the importance of Specialty societies and invited representatives of two of them (Neurophysiology and Geriatrics) to invite the trainees to consider a career in those specialties. I had the pleasure of speaking on behalf of the BGS. This is what I had to say:-

Passionate kiss and sartorial critique
It was a teaching round and I was talking about sensori-neural deafness. I explained to the large entourage that it was inappropriate, unnecessary and unprofessional to shout when addressing old patients who were deaf. Better to get close and speak at a normal pitch into their ears. The 87 year old patient misconstrued my intentions – she thought I was bending forward to kiss her. She held my ears tightly and gave me an enthusiastic full-on kiss. The students and trainees were highly amused at my embarrassment. Geriatric medicine certainly keeps you humble.

I work in Leeds, a city whose wealth was based on the tailoring trade. Many of my elderly patients have been seamstresses. One disinhibited former tailoress fingered the lapel of my suit and with some disdain informed me that she had seen better cloth wrapped round a piece of cheese. Geriatric medicine is never dull or predictable

A survey of 12,000 American clinicians from 33 specialties found that geriatricians were the specialists most satisfied with their career choice. The authors were surprised that erstwhile prestigious, “procedural” specialties scored badly in terms of job satisfaction. By contrast, “cognitive” specialties – Geriatrics, Paediatrics, Dermatology, Neonatology – had unusually high levels of doctor satisfaction

This comes as no surprise to those of us fortunate to be called to this most challenging and rewarding of specialties. I can honestly say that I have never had a day at work that has been boring and have never wished that I had chosen another specialty. Geriatrics is the fruition of clinical medicine.

It is a “whole-person” specialty. Based on a solid infrastructure of general medicine, it also involves consideration of psychological, social and spiritual dimensions, together with functional and environmental assessments. A geriatrician needs to be aware of legal aspects – capacity and consent, human rights, guardianship; and ethical conundrums, such as when to investigate or treat.

Ill old people may present with overtly medical problems – heart failure, stroke, pneumonia, cancer, renal failure. Many present with less vocal symptoms – falls, confusion, immobility, cognitive impairment. The causes for these common and often misunderstood non-specific presentations are legion. To be successful in Geriatric Medicine you need to be a detective and enjoy taking time to tease out key clinical features

We rejoice in complexity. Many of our patients have much co-morbidity and assessing and prioritising their problems can be intellectually fulfilling. Philp has pointed out that Geriatrics is not rocket science – true: it’s far more complicated than that. Geriatricians work democratically with a team and co-ordinate and manage care. We recognise the heroic commitment often given by families and ensure that they and the patient are at the centre of the enterprise

Geriatrics offers a wide range of clinical interests. To be a good geriatrician, you should know something about everything and everything about something. The something you need to know everything about might be stroke, syncope and falls, Parkinsonism and other movement disorders, dementia, incontinence, or orthopaedic geriatrics. My personal interests are rehabilitation – optimising function and well-being in those with disabililties – and community geriatrics. I enjoy home visits, working with community colleagues and the challenge of improving care in care homes. As a geriatrician, you will do a lot of crisis care as well as caring for people with chronic conditions. You will discover many opportunities for prevention and health promotion. You will find that you can always do something useful for your patients and their families – even if they are frail and in the later stages of life. It is often the small things that make a big difference.

Teaching and research are central – there are negative stereotypes to be corrected and many unexplored areas awaiting the attentions of the inquisitive medical scientist.

What are the pre-requisites for a geriatrician? Clinical skills, of course. Leadership qualities, certainly. Strong communication skills, undoubtedly. Wisdom and the finesse of a renaissance clinician, surely. An enjoyment of the company of old people, indubitably. Also a capacity for hard work and the self confidence to work in a specialty which for unfathomable reasons has not always been considered a “glamorous” one.

Geriatrics is one of the major success stories of British medicine. Geriatricians are now the biggest group of physicians in the Royal College of Physicians. The rising numbers of old people and their rightful demands for high quality care mean that the specialty will continue to expand

So if you see yourself as a holistic physician, if you are ready for a challenge, if you relish diversity and complexity, and if you want to do something really useful and immensely fulfilling, you might consider Geriatrics. But do be prepared for unexpected passionate kisses and negative sartorial comments

Graham Mulley
President-elect