Dr Anthony James is a Consultant Physician at Princess of Wales Hospital.
Why train, work and live in Wales and why do Geriatric medicine here? It isn’t an easy decision to choose a specialty or move to a different part of the country. Wales is often thought of for its castles, song, rugby, dragons and heavy industry in the way of Coal and steel.
The national health services was established on the 5th July 1948 by Aneurin Bevan, a Welsh man, and today the National Health Service is Wales’ largest Employer. In recent years the NHS in Wales policy has deviated from England’s version guided by the Wales Assembly Government (WAG) based in Cardiff. Continue reading →
Barry Evans has been a specialty registrar in geriatric and general internal medicine since 2014. He has an interest in innovative models of care and that improve the health and quality of life of older people and QI Projects which improve the working lives of doctors in training. Here he discusses the Trainees’ Leadership and Management Weekend. He tweets @barryjames86
Having commenced training in geriatric medicine in 2014, I’m often surprised by the speed at which my training has gone. If the last couple of winters in the NHS are anything to go by, there is no shortage of experience in clinical work for trainees in geriatric or internal/acute medicine, and despite the recently promised ‘cash injection’ for the NHS, there is unlikely to be a shortage of clinical work soon!
This clinical work allows us to see the entirety of the older person’s care journey, as geriatricians work in the community, in A&E, in acute medicine, on wards (medical and surgical!), and in intermediate care/rehabilitation – to name just a few. Continue reading →
In a recent paper by Utz and colleagues (2014), the following is offered:
“The term loneliness is often equated with social isolation or social participation. However, seminal work attempted to distinguish loneliness from these constructs by defining it as the cognitive or psychological appraisal of social relationships and activities. For example, loneliness has been conceptualized as the lack of “meaningful” social relationships or “incongruence” between actual and desired levels of social interaction.” Continue reading →
The scientific journal of the British Geriatrics Society, Age and Ageing, and the Journal of the American Geriatrics Society have launched a joint initiative, publishing two articles debating the relative benefits and risks of treating hypertension in older people.
It is widely recognised that raised blood pressure is probably the single most important treatable risk factor for cardiovascular disease in later life. The evidence that older people can benefit from antihypertensive drugs has accumulated with a succession of randomised controlled trials over the past 35 years. These trials have shown reduced risk of stroke and myocardial infarction, as well as decreased total mortality. However, despite the extensive evidence that is now available, questions remain about who to treat and on optimal blood pressure targets. Consequently practice varies widely and many clinicians are uncertain about what best to recommend for their older patients. Continue reading →
Dr Juliette Brown is a locum consultant psychiatrist in CMHT for Older Adults in Newham and in liaison psychiatry at Newham University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.
Dr Cate Bailey is a Specialist Registrar in Psychiatry working in Liaison Psychiatry at Homerton University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.
‘Psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study’ Sigmund Freud, On Psycho-analysis (1)
Can psychodynamic theory improve our care of older adults? A century of psychoanalytic thought and a half century of work by old age psychiatrists and psychotherapists suggest that it can (2-3). Psychodynamic approaches help in making sense of complex, bewildering and frustrating clinical encounters through the recognition and observation of unconscious communication (4). By becoming aware of the inner and outer worlds of ourselves and our patients we can provide more thoughtful and effective care. Continue reading →
Rachel Manners is a speciality doctor in hospital based complex continuing care in Edinburgh. She is a particular interest in end of life care and in complex dementia care. Her twitter handle is @RachelMannes1 (due to an unfortunate spelling incident that she cannot figure out how to fix!).
Journeying beyond questions of how and why disease happen; to considering what they truly mean in the lives of individuals is one of the great challenges of clinical practice. Dementia brings out this challenge particularly strongly given the questions it raises about not only what it means to think and remember, but what it means to be. That is it to say, it forces the practitioner to consider what it truly means to be a person. For those of us who work with and for those who live with dementia (or experience it in our personal lives) these are important questions. My own practice in recent years has led me to wonder not only what I have to offer people with dementia, but also to begin to consider what they have to teach and offer me .
Dr Shane O’Hanlon is a consultant geriatrician and Honorary Secretary of the BGS. He holds a law degree and has a special interest in medicolegal matters. He tweets @drohanlon
Most doctors spend their career hoping never to see the inside of a courtroom! While geriatricians are probably among the most rarely sued specialists, we can still have quite frequent involvement with the law – the Coroner’s Court is a good example. There is also an increasing amount of medicolegal work related to dementia, deprivation of liberty safeguards and mental capacity. In this environment there has been a gap in the market for a book that focuses specifically on our needs, but retired geriatrician Dr Geoffrey Phillips is at hand with help.
“The Geriatrician in Court” is a handbook of “how to do it” based upon his thirty years of experience in preparing medico-legal reports and attending court to give expert evidence. The book covers all the main topics over the course of 226 pages. It begins with an outline of the legal system, criminal versus civil law, negligence and burden of proof. Important areas such as mental capacity, testamentary capacity, abuse, medical error and resuscitation all feature. Continue reading →
Dr Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. In this blog she discusses the recent Channel 4 programme in which she appeared, Old People’s Home for 4 Year Olds. She tweets @geri_baby
I’ve always had a soft spot for care homes. As a child I would occasionally go into work with my Mum and meet some of the old ladies she talked about. When I was older I started work in the same nursing home as a kitchen girl on Saturdays, and then later progressed to health care assistant. I remain proud of my training record from that time, showing I am competent to deliver personal care, clean dentures and cut nails.
This is why I was excited when an approach came from CPL productions, who were looking for geriatricians to be involved with a television programme they wanted to make about introducing children to a care home environment. Continue reading →
Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care. The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting. The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com
I read Roald Dahl’s ‘George’s Marvelous Medicine’ to my children today and my son said, “You really love the Grandma in this don’t you Mum?”
It’s true! It was one of my favourite books during my own childhood and I now spend a large amount of time perfecting the Grandma’s voice for my children and absorbing the story with them as they snuggle on the sofa. There is personal meaning to some of the pictures too and so a picture of George stirring the giant saucepan is hung on our kitchen wall. The text describes ‘A rich blue smoke, the colour of peacocks’, at which point we cheer because Peacock is our family name. Continue reading →