Wednesday, September 30, 2015

Why see a geriatrician?

It's not just patients, but other physicians, who have trouble figuring out what I do and when I should do it.  Is it when a person turns 65?  Or when they develop problems with memory like dementia?

Here are a list of reasons
1.  The patient has multiple medical problems.
At some point managing multiple medical problems becomes an art in itself.  A typical patient might see a specialist for every one of their medical problems, with the inevitable increase in the complexity of managing them.  A geriatrician might take that patient, put it into a big picture and treat the big picture.

2.  The patient has functional decline.
Geriatricians know about mobility issues, health implications of falls and how to collaborate (not just refer) to physical therapists and rehab physicians.

3.  Age
This seems obvious but what geriatricians understand about aging is that it can modify the benefit and harms of what we do in medicine.  Understanding how age and future prognosis modifies risks/benefits is a geriatric skill.  Decisions like when to stop cancer screening or what is the ideal blood pressure or sugar target, the decision to treat or not treat a disease (like surgery for a back problem or blood thinners for an irregular heart beat) all have age as a consideration

4.  Geriatric syndromes
Geriatric syndromes are multi-organ.  Geriatricians specialize in multi organ stuff.  Falls, incontinence, memory loss, psych issues, polypharmacy, pain, wounds etc.

5.  Patients who have mixed palliative / therapeutic goals
Some patients want to pursue therapeutic/curative care for some of their medical problems and forgo aggressive treatment on others.  Some docs want pts to be all or none (full code or hospice).  Geriatrician (ideally) would be able to straddle the sometimes messy space between full therapeutic care and hospice.

6.  Pt's who transition between health systems
Geriatricians receive training in hospitals, offices, house calls, assisted living facilities, rehab facilities etc.  We know the pros/cons/limits of each and how to make things work.  Ideally these transitions are not stressful.

7.  Pts who need collaborative interdisciplinary care
A large part of what we do is working with other disciplines such as physical therapy, occupational therapy, speech therapy, nutritionists, wound care nurses, social workers, home health aides, medical supply companies, hospices.

8.  Caregiver support
This is something assessed (I feel) better by geriatricians than non geriatricians.  It's not just the patient we care about but also the support team (family and friends).