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In Defense of a Department of Geriatrics
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IN RESPONSE:
Dr. Gilson asserts that geriatric medicine has always been subsumed as a major aspect of internal medicine. Although internists see an increasingly large number of elderly patients, unfortunately that in itself does not mean that most internists are well trained in the content and principles of geriatric medicine. Early leaders in the field of geriatrics, such as eminent internist Paul Beeson, pointed out that the specialty of geriatric medicine as recognized in other developed countries around the world includes a significant body of knowledge about aging and age-related syndromes, as well as a different approach to the patient in which functional assessment and functional goals are coupled with diagnosis and treatment. Such leaders as Beeson and Hazzard would argue that internal medicine ought to incorporate this body of knowledge and approach to care, especially in light of the aging of the population. I also share that view and articulated it during my term as president of the American College of Physicians. Unfortunately, however, many internists have not had this training and are unfamiliar with functional assessment and with recent advances in aging research. Furthermore, while this situation is improving somewhat, there is still a great deal of room to enrich the curriculum in medical schools and internal medicine residencies, making it more useful for physicians caring for patients of advanced age. Geriatricians do not replace the other specialties in medicine, but they must have extensive familiarity with these other disciplines in order to effectively coordinate the care of the patient who requires multiple referrals. Many internists have learned the principles and content of geriatric medicine through continuing medical education courses, reading of the literature, and relationships with other colleagues. I suspect that Dr. Gilson's definition of a competent internist may be very close to my definition of a good geriatrician.
- Copyright ©2004 by the American College of Physicians
