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Geriatricians are statistically most likely to be Capricorns. Margot Gosney told us this at the BGS Spring Conference in Manchester. She had conducted detailed analysis of the dates of birth held in the BGS members’ database. Having reported her findings, Margot moved on to discuss the implications. Capricorns, she told us, are determined, hard-working, ambitious and pragmatic – attributes she recognised in the colleagues filling the room. But she went further. There are within the specialty, she postured, garden goats and mountain goats. Garden goats are content to stay inside carefully hedged-off areas and determinedly mow the grass all day. Mountain goats, meanwhile, risk life and limb in ambitious forays to scale the highest peaks. Both, she suggested, are necessary.

Ray Tallis is, by any reckoning, a mountain goat. He is the only geriatrician to have featured in the Independent’s list of 50 “Brains of Britain” and, more importantly, to have guested on Desert Island Discs. He treated us to a characteristically charismatic demonstration of intellectual persuasion as he made the case for Physician-assisted dying at the conference. The official BGS position against Physician-assisted dying has not changed. Ray’s talk, though, gave us an opportunity to consider our position. Despite his best efforts I was struck by the fact that most colleagues seemed to finish the session feeling roughly the same about the issue as they had at the start. Could it be that, upon matters of such importance, we tend to follow our heart, or gut, rather than the persuasive rhetoric of even the most renowned of mountain goats?

“Determined, hardworking and pragmatic” could be used to describe Dr Kate Granger, who also provided a memorable talk at the conference. Actually, words to describe Kate adequately are difficult to find but her determination to lead her life in public, as she lives with a diagnosis of terminal sarcoma and shares her experience as both a doctor and a patient with as many people who will listen, brought many members of the audience to tears as she spoke on Thursday afternoon. Kate came to share how her experiences on social media – and particularly using Twitter – have helped to transform her life and parts of the NHS for the better. She rightfully received the President’s medal.

As a pragmatist – and Twitter fanatic – Kate would want me to tell you that the social media footprint of the BGS Spring conference was the most impressive we’ve seen to date. There were 1,791 tweets from 305 participants during the conference. Through the impressive multiplicative effects of twitter, that means that the conference featured in the twitter feeds of some 1.8 million users over the three days. This must be caveated with the average life expectancy of a tweet – 6 seconds – but the possibility of new technologies to open the society and geriatric medicine up to new audiences are writ large. Against this background, the appointment of a new digital media team – in the shape of Shane O’Hanlon and Yoganathan Suthahar – to take over the BGS blog and twitter feed is very exciting indeed.

Two sides of the media coin

Digital media featured prominently in our responses to the BBC documentary “Protecting our Parents” and the Panorama programme “Behind Closed Doors”. The latter programme presented harrowing examples of the worst care experienced in care homes, without balancing the account by showing the exemplary care that also takes place in such settings. The social media backlash was as expected. I was up till well after midnight signposting lay-people, health professionals and journalists to BGS documents that provide more balanced accounts of what can and must be achieved in long-term care. Quest for Quality, Failing the Frail and the BGS Guidelines for Commissioning Health Care in Care Homes all featured heavily. After midnight, things settled down and several users, in the throes of outrage minutes before, went back to posting pictures of their cats. The following morning I went back to work with the garden goats and the mountain goats and we got on with the business as usual – which for me, as a community geriatrician, involves improving the lot of the care home residents the cat poseurs had long since forgotten.

That is, I think, what Margot was getting at. If we’re going to make the lot of older patients with frailty better, then we need to be out proselytising about what can be done whenever we can. This might be on twitter at midnight, it might be at commissioning meetings, it might be in hospital grand-rounds or in undergraduate teaching. Wherever there is anybody that will listen, or ought to listen, we as a specialty need to be there with something to say. But we also need to turn up for work in the morning and keep working, in the most practical way possible, to improve care for older patients. We, all of us, need to be a little bit garden goat and a little bit mountain.

Adam Gordon

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