How to … be a jolly good fellow

Elinor Burn is a Department of Medicine for the Elderly (DME) and Quality Improvement (QI) fellow at the University Hospitals of Derby and Burton NHS Foundation Trust, in this blog article reflects on her year in post.

Taking a step off the conveyer belt of medical training can be a daunting move for trainees, who have become accustomed to the continued encouragement for career progression. It’s a choice that is not actively encouraged, but does allow(s) space to refocus through dedicated time doing a different kind of work.

After crawling to the end of my core medical training feeling exhausted, I took on this year as a chance to change gear, step back and remember why I enjoy and chose to do medicine. By filling this fellowship post I accepted the challenge of taking forward a service design programme. This has been in the form of a surgical liaison service, a project still in its infancy. It was a steep learning curve – service development is something that I’ve never actually been taught to do. Continue reading

Frail Fail: Four Thoughts on Framing Frailty Teaching

James Fisher is an St5 in Geriatric and General Internal Medicine currently working at Northumbria Healthcare NHS Foundation Trust. He has an interest in medical education, is the co-founder of the Association of Elderly Medicine Education (aeme.org.uk) and tweets at @drjimbofish.shutterstock_114512884

I remember as a medical student attaching myself to a ward round with a busy senior physician. We had just reviewed a patient, an elderly lady, who had been chatting away happily to the consultant. The clinical details of the case have long since faded from my memory but I do vividly recall that as we walked away from the bedside, the clinician said to me: “Well, unfortunately she is clearly dying”. This hit me like a train. The idea that the patient I had just seen, who seemed so full of life, was dying, had never even entered my head. Continue reading

The Future Hospital Commission: future-proof doctors need training in geriatric medicine

Dr Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Deputy Honorary Secretary of the British Geriatrics Society and also edits this blog. 

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The report of the Future Hospital Commission, published last week, suggested we needed “a cadre of doctors with the knowledge and expertise necessary to diagnose, manage and coordinate continuing care for the increasing number of patients with multiple and complex conditions. This includes the expertise to manage older patients with frailty and dementia.”

The most evidence-based way to manage frail older people is Comprehensive Geriatric Assessment (CGA). CGA has consistently been shown in large meta-analyses and systematic reviews over the last 20 years to improve outcomes for older patients. These include – but are not limited to – decreased risk of cognitive decline and death, increased likelihood of functional independence and a lower probability of readmission to hospital.

Doctors don’t “do” CGA – it is delivered by a multidisciplinary team (MDT). It requires assessment across multiple domains (medical, psychological, environmental, social and functional), accompanied by case management and iteration of management plans.  The role of doctors is to provide diagnosis and prognosis, to initiate medical treatments where necessary and to do so with consideration to the broader management plan agreed with the MDT.

If doctors are to do this they need first to understand how CGA works. Continue reading

The future of hospitals is age-attuned

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

orange geriatrics

The Future Hospital Commission (FHC) has published its report and recommendations for ensuring that hospitals are designed around the needs of patients. The report recognises that older, frail and more complex patients with multiple long term conditions are the main patient group cared for in modern hospitals. It is critical that we meet the needs of these vulnerable individuals.

The FHC places welcome emphasis on the importance of Comprehensive Geriatric Assessment (CGA) but at the same time there are significant workforce implications for the expanded use of CGA in general hospitals.

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Being The “Med Reg”

Dr Sean Ninan is a registrar in Geriatric and General (Internal) Medicine in the Yorkshire Deanery. Here he reflects on a recent report from the Royal College of Physicians on the role of the Medical Registrar and how it it compares with his personal experience.

I was on call a few weeks ago and was shadowed by some keen medical students. It was a busy day and I spent most of the day in the resuscitation area of the Emergency Department. There was a handful of patients with COPD and type 2 respiratory failure requiring non-invasive ventilation, a couple of patients with pneumonias and severe sepsis, one who was peri-arrest with anterior T wave inversion and one with S1Q3T3 on their ECG who had a massive pulmonary embolism, and a young man with ischaemic extremities, pleuritic chest pain and a butterfly rash…

The students loved it. They found it fascinating, exciting, intimidating and then…

“I could never be the Med Reg”

It has always been so, yet increasingly trainees seem to be put off by acute specialties and the burden of the general medical take at a time when acute services are under increasing strain.

In this context, I was particularly interested in the recent publication by the Royal College of Physicians “The medical registrar. Empowering the unsung heroes of patient care.

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Streamlining admissions

Dr Sean Ninan is a Specialist Registrar in General (Internal) Medicine and Geriatric Medicine working in the Yorkshire deanery, UK.

When I was 20 I travelled round India, a wonderful beguiling country with some of the worst administration I have ever encountered, much of it unchanged from systems introduced during the Empire.

I have fond memories of the trip but there were many frustrating experiences too. Taking out money from the bank, for example, was particularly painful.

You enter, make your way to reception and explain that you would like to take out some money. They ask you to take a ticket, and you wait in the queue. After some time, patiently waiting you reach the front of the queue.

“Saving, deposit or withdrawal?” Continue reading

Time to catch up: dementia, medical education and 21st-century healthcare

Dr Ellen Tullo is a Teaching and Research Fellow at the Biomedical Research Centre in Ageing at the University of Newcastle, UK.  Her particular area of interest is in how we teach about dementia in order to improve outcomes for patients.

In centuries past, medical students in the UK studied rheumatic fever, smallpox and syphilis as a reflection of the needs of the community that they served. However medical advances and demographic change mean that health and social care professionals now face new challenges and opportunities.  Many of these are related to ageing and the need to provide the best possible care to an increasing number of increasingly complex frail older patients. In this context, dementia is an area of current – and growing – importance.

Over the last decade, multiple national audits, reports and policy statements highlighted concerns about the care afforded to people with dementia in both primary and secondary care.  The recurrent message from these documents was that education and training about dementia for health and social care professionals must improve.

Moreover, just in the last few weeks , the government’s response to the Francis report reiterated the importance of the issue by affirming their commitment to improving dementia-related training for professionals. So the past decade of auditing, reporting and policy stating does not seem to have prompted the necessary change.

How should we take things forward?

Continue reading