Description
Ahorrible sense of deja-vu struck me at the BGS scientific meeting in Brighton earlier in November. There were several very good presentations on the value of care home medicine and, in particular, the need to improve medicines management and the management of long-term conditions for care home residents. Unfortunately, discussion frequently degenerated into a one-sided, us (geriatricians, aka the good guys) and them (general practitioners, aka the bad guys) slanging match. I am just old enough to remember the battles waged between general physicians and geriatricians (we can do it so much better than they can) and can certainly remember those between geriatricians and orthopaedic surgeons (they should stay in theatre and let us look after the patients). In both instances, the negative stereotyping eventually turned to a language of collaborative working and patient care improved. Lets not go down the same tortuous route with care home medicine! Geriatricians should see their colleagues in primary care as allies and seek to work with them not antagonise them. Can we not put aside our egos, power-bases, stereotypes and prejudices so that we can build a service fit for our customers frail older people? God forbid that we should need to go in to care but many of us will need to. So, lets be a little selfish and work together to build a system that we might feel safe in. Not all geriatricians feel comfortable doing community work, so why should all GPs be expected to engage with care homes? Each to their own interests and then maybe those with interest will be expert and the world will be a finer place for us all to be looked after in (should we need it). So please, please, please think before opening your mouth at conferences, especially when those that you attack are not there to defend themselves and should be considered partners anyway. Remember that words can speak louder than deeds!
And whilst Im on the subject of collaborative working, I recommend reading the National Confidential Enquiry into Peri-Operative Deaths (NCEPOD) An age old problem (published November 2010). Is your surgical liaison service proactive or reactive? If it is the latter, how often have you said that what your surgeons want is a takeaway service? If that rings true, then let me ask, why havent you developed a can I help you approach? Now consider how you can work with your local surgeons and anaesthetists to ensure that more than 36% of older people receive good peri-operative care and write that joint business case for the necessary man-power!
I have often been asked why the journal does not run with themes for each volume. It is extremely difficult to co-ordinate many different reviewers to come in on schedule around a single theme. However, if the various SIGs and Sections of the BGS wished to plan a series of high quality reviews within their areas of expertise this would be welcomed by the editorial board. There is a wealth of expertise out there in the BGS dont keep it to yourselves, share it with others through your CME Journal.
As always, I welcome feed-back from you as to whether the journal is helping you to fulfil your CME needs.
Duncan R Forsyth
