How we built a Geriatric Service in the ‘largest hospital in Europe’

Caroline Whitton is a Geriatrician working in NHS Greater Glasgow and Clyde currently based in the Victoria Infirmary, Glasgow which is soon to be subsumed into the South Glasgow University Hospital. She has several educational roles which include Foundation Programme Director, Consortium Lead for NHS Education Scotland and Associate Director of Medical Education for NHS Greater Glasgow and Clyde.

For me, the adventure began when I was asked to deputise for my Clinical Director at a meeting to discuss junior doctor staffing of a new admissions unit. The meeting was hosted by the medical directorate, and I was the lone geriatric voice amongst a cast of many. From that meeting began a process that has, for the time being, taken over my professional life! Do I regret my initial impulse to go along? No – because it initiated a journey which has enabled me to be involved with the design of a completely new service. It has made it possible for me to influence the way in which I provide care to my patients and deliver training to my junior colleagues.

Be the Master of Your Own Destiny (with a little help from the BGS!)

Dr Sarah White

In my fourth year as a medical registrar I was feeling disheartened with gruelling on-calls, never ending night shifts and the constant daily battle and bureaucracy on the wards.  I decided to undertake a masters degree to re-awaken my passion for learning and medicine.  I opted to do the Gerontology Masters at King’s College, London.

 

Several friends had undertaken part time MSc’s and all had bemoaned the difficulty of balancing a full time job and on-call commitments with essay writing, examinations and lengthy dissertations.  As one part-time masters friend put it, she did “just enough to get by”, which greatly reduced her masters experience.  I wanted to the get the most out of my masters and give it my full attention hence decided to do it full time over one year.  However, the major downside of being a full time student is lack of income!  Masters fees are expensive (mine cost £6,500), regular travel to university from outside London was not cheap; printing and photocopying costs were an unexpected and substantial outgoing; not to mention the ever increasing cost of living.  Needless to say I relied on personal savings, sporadic locum shifts and a very understanding fiancé to support me through the year.

Geriatric Medicine and the burden of common sense.

Prof Kenneth Rockwood is Director of Geriatric Medicine Research at Dalhousie University, Canada and serves on the International Advisory Panel of Age and Ageing journal. 

I’ve been teaching geriatric medicine for about 25 years. During that time, my attitude towards the common sense of geriatric medicine has changed. At first, I saw it as a great blessing: it was easy to let people know what they needed to do. Then I began to see it as a challenge: an audience could sit through a diverting 40 minutes, but in the end not be persuaded that they have learned anything. “Nothing to that – it’s all common sense”. Now I see the common sense of what we do as a foe, and one that we should conquer.

Shape of Training Report – more clarity needed before the opportunities can be realised

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. She tweets at @geri_baby

A joint position statement has been released by the Royal Colleges of Physicians (Edinburgh, Glasgow and London), and JRCPTB on the Shape of Training report (ShOT). Since the publication of Professor Greenaway’s report late last year there has been a considerable amount of concern that the recommendations contained within would lead to the decimation of postgraduate medical training in the UK, resulting in a sub-consultant level and inadequately trained doctors. I previously blogged about this in November 2013.

The more you study, the later you drop – Education and terminal cognitive decline

Graciela Muniz-Terrera is a Senior Investigator Scientist at the MRC Lifelong Health and Ageing Unit at UCL

The terminal decline hypothesis suggests an acceleration of rate of cognitive decline before death, although information about the onset of faster decline is inconsistent and varies by ability examined. The identification of factors that may delay such onset is crucial for policy implementation, as such delay would imply that individuals spend a shorter period of time in the fast declining stages of life. Education is a modifiable risk factor usually considered as a proxy for cognitive reserve that has been shown to be associated with cognitive function and, in a few American studies, has also been shown to be associated with a later onset of preclinical dementia.

Choose the red pill, choose geriatric medicine

“I know exactly what you mean. Let me tell you why you’re here. You’re here because you know something. What you know, you can’t explain. But you feel it. You felt it your entire life. That there’s something wrong with the world. You don’t know what it is, but it’s there. Like a splinter in your mind — driving you mad. It is this feeling that has brought you to me. Do you know what I’m talking about? 

‘She’s been up at casualty with another fall’

Consultant geriatrician at the Queen Elizabeth Hospital in Birmingham and co-chair of the BGS Falls and Bone Health Section, Dr Jonathan Treml, advises on how to tackle this common tricky presentation in a ten minute consultation.  This article first appeared online in Pulse, a website aimed at GPs and other primary care professionals and which tweets @pulsetoday.

Falls are a common and potentially serious problem affecting around a third of older people each year. Often disregarded as an inevitable part of the ageing process by both patients and doctors, falls can be the first sign of frailty, disability and dependence.

Most falls in older people are the result of multiple risk factors, often including impaired gait, balance and mobility. Falls can be the presenting complaint of underlying pathology – including postural hypotension or syncope, vestibular or visual impairment, Parkinson’s or other neurological disease.

A doctor’s main roles in falls prevention are identifying and treating underlying problems, ensuring medication is reviewed for fall risk and bone health, and appropriate referral to falls prevention exercise programmes.

When I was a young ‘un – The changing professional life of the geriatrician

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

The changing professional life of the doctor was also the subject of a session on medical education which looked at how modern methods have replaced those of a generation ago. As Dr Rick Plumb, clinical senior lecturer at Queens University in Belfast, put it “The main difference between now and my student days in the early 90s is that there is no point rote learning ten facts when you can access the best information instantly. In the old days learning about morphine, say, would typically involve looking at not very inspiring didactic slides. Now learning is active with built in bookmarks and links.”

Your speciality needs you…..to write questions for the MRCP(UK)

Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People based in Nottingham, UK.  He is also the editor of this blog.

Good CPD can be hard to come by.  Sure, there are endless opportunities to attend symposia and conferences and workshops and away-days……but how often do you engage in a piece of CPD that makes you reflect critically on your understanding of key aspects of your work as a geriatrician, or that makes you question the essence of what it is that separates your specialty from the others, or what makes geriatrics relevant to patient care?

If you’re looking for something more than powerpoint presentations in glamourous venues with finger-food of varying quality, something that encourages you to think deeply and reflect on what it is that is most important about being a geriatrician, then I may have just the thing for you.

Geriatric Registrar training – is there too much G(I)M?

With the advent of Modernising Medical Careers, most medical specialities secured their trainees the option to relinquish General (Internal) Medicine – G(I)M.  Cardiology, gastroenterology, endocrinology, respiratory and rheumatology registrars can opt out to undergo speciality-only training, or specify that only 2 out of the 5 years will include acute G(I)M take.

Geriatrics is now the odd one out. Most geriatric trainees undergo 5 year rotations with very few having speciality-only periods of training.

Is there too much G(I)M?