If frailty is viewed by some as a “commissioning Trojan Horse” this should be admitted

Dr Shibley Rahman is currently an academic physician in dementia and frailty. His contribution on the diagnosis of behavioural frontal frontotemporal dementia, published while he was a M.B./Ph.D. student at Cambridge in 1999, is considered widely to be an important contribution to the field, even cited in the Oxford Textbook of Medicine. Here he responds to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?  He tweets at @dr_shibley.

In response to Steve Parry’s recent BGS blog, The Frailty Industry: Too Much Too Soon?, I would simply in this article like to set out some of the strengths and weaknesses in the conceptualisation of frailty, with some pointers about “where now?

There is, actually, no international consensus definition of frailty (although there is one of a related term “cognitive frailty”).

In a world of fierce competition for commissioning, and equally intense political lobbying in health and social care, the danger is that a poorly formulated notion becomes merely a “Trojan Horse” for commissioning.

I must humbly depart from the views of some colleagues – for me, frailty is not just a word. I could likewise point to other single words which cause gross offence, which are unrepeatable in my blogpost here. Continue reading

NHS – A giant Diogenes syndrome

Adhi (V Adhiyaman), geriatrician and Chair of Welsh council of the BGS. Tweets at @adhiyamanv

220px-giovanni_battista_langetti_-_diogenesDiogenes was a controversial Greek philosopher who lived in the fourth century BC. He was a cynic and rejected many conventional ideas and lived in a large clay jar in the city of Athens. He lived in a squalor and rejected ideas of normal human decency.

Diogenes syndrome is a disorder characterized by self-neglect, domestic squalor, apathy, compulsive hoarding of garbage and more importantly lack of shame. The syndrome does not refer to the intelligence or the philosophies of Diogenes but rather refers to the way Diogenes lived. A person with primary Diogenes syndrome is intelligent but aggressive, stubborn, suspicious, emotionally labile and has an unreal perception of life. Continue reading

Francis Report – A Nursing Perspective

Jane Buswell is Chair of the BGS Specialist Nurse and Senior Practitioners Group

On reading the Francis report one might be misled into thinking that the report points to nurses as having sole responsibility for delivering compassionate care and that the only professionals delivering care within the NHS are nurses and doctors. It is unfortunate that the significant role of our Allied Health Professional colleagues within the multi-disciplinary team, and their potential for leadership, has not been recognised in this wide ranging and seminal report.

It would be wrong to look at the individual professional recommendations in isolation. Only 33 of the 209 recommendations are specific to nursing. However, many of these are addressing the same issues of leadership, training, regulation, professional accountability and the roles of our professional bodies, all of which apply equally to doctors, and all other professionals within the NHS. Continue reading

Bones and a reflection on training opportunities

I have to admit, bones do play a key role in my life, not only do they allow me to get about, safely protecting my internal organs, balancing my calcium and providing me with a ready supply of haemopoetic cells, but bones also provide the ‘back-bone’ to my working life both as an orthogeriatrician and as an epidemiologist.

I remember when I was starting out as a SpR in geriatrics; I had that feeling of wanting to ‘do some research’, but was in that all too common position of wondering ‘where do I start’? That year a course was advertised in the BGS newsletter ‘Osteoporosis and other metabolic bone diseases’. I was just beginning to develop an interest in orthogeriatric medicine and this residential course, run at one of the Oxford colleges and specifically aimed at trainees, offered a comprehensive overview of osteoporosis biology, treatments, monitoring, and radiology, as well as topics such as renal osteodystrophy, primary hyperparathyroidism and Paget’s disease. It proved a really educationally valuable few days and the course manual provided an excellent reference resource for a number of years.

Continue reading

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?

Continue reading

Phone App Review: Qx Calculate

Qx Calculate

Costs: Free

Devices: iPhone, iPad, BlackBerry and Android

Target Audience: All levels of doctors

Review: Ever needed to calculate a GRACE score in a chest pain patient? Or an eGFR in an elderly patient about to initiate bi-phosphonates?  RANSON score in pancreatitis? This excellent medical app for your phone provides ‘at your fingertips’ access to wide variety of medical risk scores.

The app can be customised to UK laboratory units. All manner of scores from Cardiology to Gastroenterology to Neurology to Cardiac surgery are covered and updated free of charge. This would be an invaluable tool on ward rounds or on an on-call shift in the emergency department. Highly Recommended.

For more details and to download, visit the website.