Published Jul 2, 2009
I just read this column about how doctors often don't get any geriatric training, despite the fact that a huge portion of their patients are elderly, and this often leads to quite bad medicine.
"All medical students are required to have clinical experiences in pediatrics and obstetrics, even though after they graduate most will never treat a child or deliver a baby. Yet there is no requirement for any clinical training in geriatrics, even though patients 65 and older account for 32 percent of the average doctor's workload in surgical care and 43 percent in medical specialty care, and they make up 48 percent of all inpatient hospital days. Medicare, the national health insurance for people 65 and older, contributes more than $8 billion a year to support residency training, yet it does not require that part of that training focus on the unique health care needs of older adults. Medicare beneficiaries receive care from doctors who may not have been taught that heart attacks in octogenarians usually present without chest pain, or that confusion can be due to bladder infections, heart attacks or Benadryl. They do not routinely check for memory problems, or know which community resources can help these patients manage their conditions. They're uncomfortable discussing goals of care, and recommend screening tests and treatments to patients who are not going to live long enough to reap the benefits."
So, how many of you have noticed this problem with your patients' doctors? How many of you felt you receive or have received adequate training in caring for older adults?
Yes, I do.
Some do and some don't and most fail to utilize services available to help them manage their patients. Most have never had a lecture let alone a course in pain and symptom management yet they think they can manage all types of pain. Most don't know all that's available except what the drug companies bring to them. We have a Palliative Care team, not Hospice, available yet our referrals are few and far between even though our Press Gainey pain scores are in the 80s. Most docs think they can handle all by themselves and rob the patient of needed services. Sorry for rambling. I truley am not a doc basher.
Thanks for the info. Oh, and I'm not a doctor basher either :) Maybe the thread title sounded a little snarky, in retrospect... sorry all you doctors out there!
I'm just trying to get a sense of how pervasive this problem in medical education is from people who would know. I live with a med student, and we had recently been talking about geriatric medicine after I took my CNA class a few months ago. He's only a second year, so who knows what more he'll learn about geriatrics in the next two years (although he certainly doesn't have any geriatric clinicals scheduled), but it really does seem like the columnist was spot on. My roomie really hasn't received much education so far on the specific problems of treating older adults. He obviously has a lot to learn, and doctors can't learn everything, but if this gap in knowledge is causing lots of patients more pain and sickness it seems like something needs to change!
CoffeeRTC, BSN, RN
Just like peds are not little adults. Geriatrics are not just old people. They are different and should be treated as such. Often times med doses need adjusted, the treatment plans need to be adjusted, family and patient wishes need to be considered....a lot of docs don't get this.
So yes...I think a specialized course should be taught or considered.
Geriatrics has been a specialty that requires 2 more years of residency but he may get some in the next years. The founder of the Palliative Care Service at New York Mt. Sinai did a residency in Geriatrics before she changed to PC and is now head of CAPC. In all of her 9 years after college she never had a lecture or course in pain management, so how many other docs have any? No I did not think you were bashing docs, but I felt like I was maybe because I am so frustrated that our PC service is not being utilized for assisting with pain and other symptom management. Keep asking questions as that is how we learn and get smarter.
When I tell them what the patients need and they agree with me....then yep.
Good answer, ditto for me. I see my folks every day and know them better than the docs. I tell them what I see but also what I think and they appreciate that. I feel that I am responsible for thier well being, not the docs.
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