President's column

Written on .

It will be the BGS’s 70th birthday in 2017. As one of the biggest medical speciality societies in the country, we aren’t in danger of disappearing and our membership (3,250 at the time of writing) is at a record high.

At this rate the BGS will be old enough to be one its members’ own patients! The Society’s foundation coincided with that of the NHS and caught the eye of ministers early on as a potential solution to pressing problems.

I attended my first BGS Spring Meeting in 1993 as a Medical Registrar – the year I joined the Society. I worked out the other day that Nottingham in May was my 35th (no-one gets to them all!).  Those early meetings made a real impression on me but “going to BGS Conference” has always been a highlight of my calendar – not least because there are so many fantastic colleagues and friends to catch up with, set the world to rights, swap information and air collective moans. I always go back to the day job with new insights into better care for older people.

A perennial feature of my time in geriatrics has been suggestions from some of our number that we have somehow lost our mission or core values, sold our soul and betrayed the Society’s principles. I strongly dispute this view and having heard several prophets of doom across three decades, I’d say our foundations are still solid and our house as strong as ever. All specialities evolve with the times. During that same 1993, Coronary Care Units were run by jobbing on call doctors, with streptokinase and TPA the mainstay of treatment and middle-aged patients frequently dying of complications. Has Cardiology somehow “sold out” because of 7/7 speciality leadership, ACS protocols and urgent revascularisation?

Over the 26 years I’ve been qualified, we’ve lost around one third of our acute beds, length of stay has shortened dramatically, urgent hospital activity has doubled and the age, frailty and complexity of hospital inpatients has altered to the point where geriatrics is now “core business”. The long-stay units I remember working on have gone, as have most old-style day hospitals. But geriatricians are embedded and prominent in acute general medicine and consistently working in “geriatric assessment units” much closer to the “front door” of the hospital. Rapid assessment clinics to provide Comprehensive Assessment for older people have grown. Integrated community rapid response and intermediate care teams provide a range of supports that no longer necessitate a trip to a building. The more things change, the more they stay the same.

At the BGS’s very first meeting of nine people, chaired by Trevor Howell, its aims were defined as “the relief of suffering and distress among the aged and infirm by the improvement of standards of medical care for such persons, the holding of meetings and the publication and distribution of the results of research”.  As we approach our 70th anniversary, we may use less paternalistic language, focusing more on enabling and empowering people but we haven’t changed that much. 

In 1949 Professor Norman Exton-Smith described the role of the speciality in “Medical Management, Rehabilitation and Long-Term Care of Older People”. In 1977 Dr Cross wrote a BMJ paper “Geriatric Medicine – death and rebirth”, showing there’s nothing new about this soul-searching. He described the early influence of the BGS thus:  ‘persuading the health minister to appoint more geriatricians as the NHS grew; an emphasis on the assessment and care of frail or disabled patients by a geriatrician and multidisciplinary team; discharge home for those who recovered; patients who were frail, disabled and previously often classified as senile were reassessed and often found to have modifiable disease; in turn more patients were able to return home enabling the use of beds for other specialties and the updating and decorating of facilities’. 

 I’d like to think that any of our earlier pioneers, would be pleased to see how far we’ve come and would see their values and mission were alive and well. 

Can you imagine them being displeased to discover that Geriatric Medicine is now the biggest internal medicine speciality – with at least 1,500 UK Consultants - a fact that always astounds colleagues overseas where Geriatrics is often small and struggling for a foothold outside academic centres); or that we consistently attract high calibre trainees who have actively chosen the speciality yet are also trained in acute internal medicine;  or that several hundred of our consultants now have community or interface roles; or that far from  abandoning long-term care, the BGS has produced a suite of publications on care homes, and community assessment of people with frailty, provided clinical leadership to intermediate care;  or that Dr Irvine’s pioneering work in orthopaedic-geriatrics has now mushroomed into a National Hip Fracture Database and Audit with geriatric involvement in trauma services being the norm; or there is now a growing role for geriatric medicine in peri-operative services supporting other surgery? 

I feel confident that if long-departed geriatricians could have ghosted into our Nottingham Spring Meeting, they would look on with pride and approval. If they do have social media up in heaven, perhaps they could even follow the tweets on #BGSConf (now “storified” for each of the three days).  They’d see that every one of Bernard Isaacs “Geriatric Giants” of Falls, Immobility, Incontinence and Confusion was discussed fulsomely – for instance in a whole day on care for  people with Dementia, presentations and posters on Delirium, Falls, Rehabilitation and Intermediate Care for “discharge of patients who are frail or disabled”.  “Support for the vulnerable and infirm” was to the fore throughout the three days. 

Despite our ongoing BGS dialogue about the range and quality of science presented at our meetings, (notwithstanding the large amount now also showcased at well-attended Sections and Special Interest Groups) the abstract book contained around 96 posters or platform presentations. This did not include all the guest presentations by experts in their field. The founders would see that their legacy hasn’t been squandered.

Before the meeting, I started a twitter hashtag #youknowyoureageriatrician (when) – partly for fun but also to “crowdsource” my Presidential after-dinner conference speech with the most humorous or moving tweets. A US writer, Linda Abbit became interested and wrote it all up for the “Senior Planet” online magazine.  If you want to feel good about who we are and what we do –and understand our collective psyche and credo then do read or contribute to the hashttag (still open for business) and Linda’s article (page 8).

So if we do start succumbing to doubt about what we stand for, the good we do or the commitment of geriatricians 68 years on from the first BGS meeting, this outsider’s view should re-affirm it. I don’t pretend there aren’t dark clouds on the horizon for health and social care. The Queen’s speech didn’t promise the scale of funding increases that independent bodies such as the King’s Fund or Health Foundation say we need just to keep up with demand. It said still less about reversing the huge local government funding cuts which put social services for older people and their carers  in grave danger. Whilst geriatric medicine can’t just “take in its stride” these challenges, we have ample evidence that our speciality and its members will endure. With one in five of the population projected to be over 65 by 2030 and with the care of older people with frailty now key to the whole health and care system, the 550 who attended the Nottingham Conference and the thousands more who followed it on social media can continue to be in the vanguard of change as much as those nine pioneers were in the first meeting that Trevor Howell convened.

David Oliver

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