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Following in the pioneering footsteps of Duncan Forsyth, Finbarr Martin and David Oliver, John Gladman and Maeve Rea braved the intense hospitality of the Taiwanese Fellows in the second week long teaching programme.

Said John Gladman, “Whilst we were in Taiwan, we recognised that the Fellows needed higher level input than simple coverage of the basic elements of geriatric medicine. Accordingly, we provided some professional developmental teaching, choosing topics such as teaching, communication skills, clinical effectiveness, critical analysis and service structure. We were also able to comment on some of the Fellows’ research work in progress.

An important theme that ran througout the week was polypharmacy. During the week we came to understand how the services in Taiwan predispose towards this problem, and we compared it with the UK. We reflected on exactly how much benefit frail old people get from drugs that are only proven to work in younger non-frail populations and how much more likely they are to get side effects leading to activity limitation.

During the case-based teaching, we exposed the difficulties that we all face in stopping drugs. Thus, the catchphrase, ‘Be brave!’ came up time and time again. It takes a certain confidence to stop drugs that other doctors, often senior ones, have been prescribing.”

Where Duncan and David feasted on snake soup, John and Maeve were treated to some very mature (1000 year old!) eggs and pigs’ ears. Both dishes were wasted on John. Clearly his taste in food is a little more conventional than his taste in waistcoats.

Queen’s accent
Dr Julie Lai, one of the Fellows, said: “UK geriatricians are more focused on comprehensive care of elderly patients. Last July, Dr Khanna Pradeep had asked me, ‘Why do you talk about money so frequently?’ This question reminded me that I did put more emphasis on payment systems than on quality of care we provided. If only the healthcare delivery system in Taiwan just started to value comprehensive care for older people, we could focus on doing what should be done instead of what can be done.

I had lots of fun while talking to the British teachers. For example, I really enjoyed listening to the Queen’s accent.” [I bet it comes as a surprise to Maeve Rea to have the soft, lilt of the Emerald Isle described thus]. Dr Lai concludes: “I would like to thank all the British teachers who gave us a memorable and fruitful experience. I will be delighted to have every teacher come to my wedding...if someday I do marry.”

‘British gentleman’ and ‘elegant lady’
Dr Bill Lin, also a Fellow, said: “I did not realise the importance of the function reserve and the problem of polypharmacy in elderly people.

I was also highly impressed by the lectures on rehabilitation, international classification of function and health, clinical effectiveness of guidelines, and how to evaluate the evidence and geriatric service.

I will never forget Prof Gladman’s encouragement: ‘Be brave and stop inappropriate medications for the elderly’. The dizziness of a patient just disappeared when I stopped a drug prescribed by another doctor. I had never experienced this before. Dr Rea taught us about the urinary incontinence, drug use in elderly people, learning types, concepts of teaching, but her most unforgettable lecture was the role play. I had never stood in the patient’s shoes before, but after the role play, I learned to do so, in communicating with my patients.

At first glance, I felt that Prof Gladman is really British gentleman and Dr Rea is very much an elegant lady. During their brief stay, one achievement must be mentioned, which is their incredible chopsticks kung-fu. They can easily pick up peanuts by chopsticks, with grace, and this is difficult, even for the Chinese”.

A delegation of Taiwanese, including some of the Fellows visited England in April, and attended the Spring meeting conference. Apart from David Oliver’s valiant efforts to learn to speak fluent Mandarin in one month (presumably partially successful as there was not too much laughter while he acted as their guide), the BGS arranged for the Taiwanese embassy in London to host a reception for the delegation.

Prof Gladman concludes his report on his teaching week, saying: “‘Be brave’ was apt in another way. All the Fellows will soon be required to develop geriatric services across the country. That will mean developing collaborations and training teams. It will involve developing services for falls or incontinence, and all this will require new ways of working and overcoming administrative and other barriers.”.

The enormity of the task is not lost on Bill Lin who says: “A half of our training programme has passed. I think we must set up our own geriatric service when we go back to our working places, including case finding, MDT organisation, emphasis on functional status and cost reduction. Hopefully, our efforts will make our government aware of the importance of holistic care for older patients instead of subspecialty-orientated medical practice.”