What
does a geriatrician do?
A geriatrician is a general physician who specialises in
the medical needs of older people. In many aspects,
these may differ from those of midlife adults. Older people often have multiple medical
problems. The geriatrician is trained to look at the problems as a whole and determine how
they interact.
“Our geriatrician provided
an excellent overview,” Joan said, “and a course of treatment. I was most impressed, too, with her ability to
explain what was happening in a way that both of us could understand. And she had the time
to give us.”
The geriatrician knows
about the syndromes of ageing that are not in any particular speciality, like mental
confusion, urinary incontinence, instability and gait disorders, failure to thrive,
depression.
Too often, a
doctor might dismiss these conditions, remarking, “Well,
what do you expect. She’s 80 years old!
This is just normal ageing.” A
geriatrician will try to find an answer to the problem.
A geriatrician also coordinates care
Joan is now involved in her husband’s medical needs. After being taken to the A&E of their local hospital when he suffered a heart attack, he was cross
referred to the consultant in adult medicine
and put in the care of his team. (NB The geriatric
department might be called the department for adult health or adult medicine. Staff and patients alike are reluctant to use the word
geriatric, which unfortunately evokes an image of a worn out and decrepit elder.)
 With multiple medical problems, you need someone to keep an
eye on the total picture. Joan’s husband is taking eight different medicines (he has
asthma, a hiatus hernia and arthritis in addition to heart problems). The team reviewed all his pills, to make sure they
didn’t compete with each other and add up to a cocktail that one person
shouldn’t be taking. The team, Joan says, also
know more about the latest drugs in adult medicine, that other doctors may not be aware
of.
Rehabilitation
The job of the geriatrician is also to improve the quality of life, to keep older people
functional and independent as long as possible. Sometimes with very simple advice, such as
exercise, a patient can be made more functional and independent.
“An important part of our training,” says
Jonathan Treml, specialist registrar in geriatric medicine, “is in rehabilitation.
Geriatricians understand that older people have less physical and mental reserves to be
able to cope with the insults that life throws up. A
younger person can tolerate quite a serious
illness without other problems. An older person
requires quite a lot of time and patience to get better, as well as medicine.
“Also in our training we work closely with other
disciplines: nurses, physical therapists, occupational therapists. A patient getting better is not just what the doctor does, but what the whole team does
and the patient does.”
What attracts
medical students to train as geriatricians?
“Originally,”
Jonathan says, “I was attracted to it because it was the last speciality where you
could be a good generalist and because you could treat the whole person. Once into my training, I recognised other aspects. The
particular problems of ageing are fascinating
and they aren’t as well researched as other medical conditions. There’s lots
more scope for research.“Another reason is the fact that relatively minor conditions
can cause major problems to patients also means that minor adjustments or relatively simple treatments can give major
rewards. That can be very satisfying to a doctor.
“Older patients can be more satisfying to look after.
They have a better attitude towards health care than many younger people. On a personal level, I prefer talking to older people. Lots more of interest to say, lots more of life and
experience to  share.
“There is another personal reason which is to do with
dignity in death. The nature of our profession is that unfortunately a proportion of our
patients don’t survive. People are
entitled to a good death with dignity and attention
to detail. One of the most important things when a person is unwell is to listen to them
and to talk. We make sure they are given the time.
Our tools are our brains and ears. We don’t need to deal with lots of equipment
.”
Ask to see a
geriatrician if you think you need one
Some people find it difficult to ask
their doctor for other opinions. Do ask to see a geriatrican when you think they can be of
help to you or those close to you. You’re not
being geriatric. Just thinking clearly and seeking
what you need.
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view previous articles - see the laterlife-interest
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