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Here we are, over 60 years from our Society’s foundation - the most numerous specialty in UK adult internal medicine and yet, still the subject of debates around the rationale for our existence.

What other discipline goes through this constant battle to justify itself? At least in Britain, we are well entrenched in hospital services and responsible for large chunks of patient care. In conversation with a senior academic geriatrician this week, it emerged that having presented at a grand round in one of New York’s most prestigious hospitals, the dean of medicine said afterwards, with no hint of shame, that “only losers go into geriatric medicine – why is someone as good as you bothering?” Since our last newsletter, there appeared in the BMJ, a debate between two Australian Protagonists ; should geriatric medicine continue to exist as a speciality? Denaro and Mudge – arguing against, pointed out that it was hard to get doctors interested in general internal, let alone geriatric medicine, and that the skills required to care for older people were repeatedly under-valued; ergo we might as well accept this reality and try to engender the right skills in all doctors. This seemed to me, a tautological argument. Surely they were precisely making the case for advocates for the frail older patient. I am pleased to say that in the subsequent poll, of the nearly, 1000 responders, there was a 2:1 majority in our favour.

The BMJ can’t be faulted for highlighting issues close to our heart as a Society. In August, a paper by Steel et al, using self-report data from over 8,000 people in the general household survey, showed that conditions prevalent to older people (they named falls, dementia, incontinence, stroke and osteoporosis) were systematically less well managed than conditions of mid life and highlighted the fact (a coincidence?) that none of these conditions appeared in the quality and outcomes framework for the GP contract. More grist to the mill surely, in the case for more, not fewer specialists or skills in the care of older people.

In driving forward this agenda, there is always a balance between opposing government policy where we feel it will compromise the quality of care for older people and being seen as intransigent or “off message”. A major challenge facing our speciality now, is the drive from a number of policy documents and contractual incentives to deliver care “closer to home” and to major on pro-active management of complex patients with long term conditions. Whatever our concerns about the potential for older people to be denied appropriate acute care and assessment, we can surely make a difference by engaging fully in intermediate care, case management, care home medicine and primary care for older people. Not only can we put our knowledge as the local “content experts” into multi-agency working groups, working on service development, but also by helping to deliver and support local services. Around the country, many PCTs are buying into this concept, meaning that an increasing number of posts for geriatricians include working for at least some sessions in “the community”. This leads to concerns about the amount of training and experience we currently give in these fields to trainees and also to governance/education and support for postholders – more so if they are new to being consultants. In this issue, Steve Allen gives some helpful pointers on this subject.

Areas of common interest and overlap with other specialities are also highly topical. Over the past three issues we have enjoyed some healthy exchanges about stroke medicine, in which a number of physicianly disciplines are now involved. There is also a long established linkage between practitioners with interests in falls, bone health and syncope, as is evident in the lively and active Falls and Bone Health Section of the BGS. In this issue, our old age psychiatry colleagues have provided splendid food for thought around dementia and depression in older people and any of us would recognise that patients with dementia, depression or delirium (even where coincidental to the patients’ presentation to our units) form a great deal of our day to day activity and will continue to do so. In similar vein, there are considerable overlaps in ethos, practice skills and training between geriatric and rehabilitation medicine. I am delighted to have in this issue a colum by Prof Chris Ward from the British Society of Rehabilitation Medicine. This is hopefully the first step in discussions about joint working around education, training and service delivery and the start of a productive relationship between our two Societies.

So, onwards towards the Birmingham Meeting. The programme looks lively and interesting and we hope to see as many of you there as possible. Just thinking out loud about our scientific meetings, I do have a question to pose to the membership. Having just returned from a first rate meeting of the Falls and Bone Health Section in York, I was struck firstly, by the high number of posters and platform presentations of relevant research and secondly, by the genuine interdisciplinarity of the event (both in attenders and speakers) with doctors accounting for only around half on each count. So…I would love to know: a) whether members feel that the growing strength of speciality meetings for falls, osteoporosis, stroke etc. mean that abstracts are often submitted to those meetings instead, and perhaps not also submitted to our national meetings? (And if so, what we could do to change this); and b) whether there is general agreement that we need to make our main national meetings more inter-disciplinary in both content and delegates and, if so how we could achieve this.

I look forward to commenting on responses in my next column.

David OIiver

BGS Newsletter, Oct 2008
Issue 18 ISSN 1748-6343 18