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Tuesday, 24 July, 2007

The decrepitude of modern geriatrics

Canada's elderly population is growing, but geriatricians remain few and far between. There are only 200 geriatricians in the country, and applications to geriatrics training programs are dwindling. “Now this is a problem because that is the future of health care in Canada. And so there is a bit of dichotomy between what students want to do and what the needs of our society are,” .

Where have all the geriatricians gone?

The New Yorker's Dr Atul Gawande . His explanation applies equally well to Canada:

Applications to training programs in adult primary-care medicine are plummeting, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partly, whether we admit it or not, most doctors don’t like taking care of the elderly.

“Mainstream doctors are turned off by geriatrics, and that’s because they do not have the faculties to cope with the Old Crock,” Felix Silverstone, the geriatrician, explained to me. “The Old Crock is deaf. The Old Crock has poor vision. The Old Crock’s memory might be somewhat impaired. With the Old Crock, you have to slow down, because he asks you to repeat what you are saying or asking. And the Old Crock doesn’t just have a chief complaint—the Old Crock has fifteen chief complaints. How in the world are you going to cope with all of them? You’re overwhelmed. Besides, he’s had a number of these things for fifty years or so. You’re not going to cure something he’s had for fifty years. He has high blood pressure. He has diabetes. He has arthritis. There’s nothing glamorous about taking care of any of those things.”

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