Geriatric medicine in most
hospitals in the United Kingdom offer a
needs-based rather than an age-based holisitic service to patients that
would benefit from a multidisciplinary approach to themselves and their
often multiple pathologies. That sentence sounds like 'interview-speak'
but encapsulates a lot of the more important points.
A more detailed assessment of geriatric medicine as a career
option
follows but I am always looking for inspiration so if you can let me
know why YOU chose geriatric medicine as a career please let me know
and I'll post it up here. There is a prize for the best one (N.B. That
prize may be publication of your work on a well respected website i.e.
this one)
Advantages
- It is clinically very
satisfying and always challenging
-
Not protocol driven - decision making is always centred on
each
individual's circumstances
-
Hugely rewarding to promote independence following illness
-
Very flexible career in both hours and community vs.
secondary care
- Ethical dilemmas are a daily occurence (I think
this is an
advantage
others may not)
- GPs very supportive because second opinions do not
get
returned when a
single organ is not to blame
- Good opportunities for both research and education
- Large variety of subspecialty intrests (something
for
everyone; falls,
stroke, orthogeriatrics, dementia, incontinence, Parkinson's disease
and any of the other '-ologies' in older people)
Disadvantages
- Can be difficult to keep
abreast of current evidence in all medical
specialties
- Poor understanding from others as to what to refer
(a frail
60 year old
with diabetes, parkinson's disease, multiple strokes and now with a
pneumonia may be appropriate, an fit 80 year old with a new MI may not)
- Fairly limited scope for private practice (not
always,
depends on
location and subspecialty interest)
Consider
geriatric medicine if you like
- Older people
- General medicine
- Working in a large team
- Acute medicine
- Outpatients clinic
- Community working
- Medical ethics and law
- Teaching and education
and especially if you like
- a different challenge every
single day
Would strongly
advise against geriatric
medicine if you like
- Having a large procedure /
practical basis to your specialty
- You enjoy working in a specialty with a clear
demarcation as
to what is
'yours' and what is not
- You don't like the prospect of post-take rounds
and still
being on-call
for a large hospital overnight in your 40s and 50s
- You like finishing your ward round before
breakfast
and especially don't do it
- if you don't like getting your
hands dirty...
The path to
geriatric medicine
Historically many people came to geriatric medicine
quite late in their
career. This was for a variety of reasons. Once, like with emergency
medicine, radiology, pathology and general practice this was due to
getting stuck with your chosen career, often surgery or a organ specifi
-ology. Mostly, those days have passed for all those specialties. There
was a time when overseas trainees especially, were 'advised' that they
had better be geriatricians becuase they would not get a consultant job
in their chosen field.
I am pleased to say that more recently, trainees
have come to geriatric medicine having worked with consultants in the
specialty who have inspired them. Only a few trainees come out of
medical school wanting to be geriatricians, which is one of the
concerns with MMC. With geriatric medicine often being on GP VTS
schemes rather than on FY2 rotations there is a concern that
application numbers will fall because trainees are not being exposed to
it, and again the specialty will become a second choice for many.
I am
not certain this is such a grave concern however. Geriatricians are
made, not born (except for one or two rare exceptions) and I am pretty
sure with 5 years of SpR training or 4 years of StR training even the
most hardened of 'failed' cardiologists will be spouting the benefits
of holistic medicine and stopping unnecessary anti-hypertensives and
statins.
Conflict of interest
I am a convert to the specialty though not really
that late. As a
student I was happy to just get through medical school rather than
having a career in mind though my early thoughts were of oncology (my
elective choice). After the first three years of a medical rotation I
wanted to do medical microbiology but a friend and colleague said I
should stay in general medicine and advised a gastroenterology
interview (his own field). I didn't get that, but did have the
opportunity to do a locum post in the North West in gastroenterology to
gain experience if I wanted to try again. I decided against that (just
seem too far to travel).
After finally getting my MRCP, I had two other
opportunities presented one was a locum SpR post in diabetes and
another was as a staff grade in geriatric medicine. I sort of knew
whichever I choose I'd end up pursuing all the way. Needless to say I
choose the latter and never regretted it. Well, not yet anyway.
