“The Patients Doctors Don’t Know”
by Chris Langston
Friday, July 3, 2009 11:21
The day after I posted a blog about the importance of medical students receiving education in geriatrics, Rosanne Leipzig, MD, published an excellent op-ed in the New York Times on the same topic entitled “The Patients Doctors Don’t Know”. Dr. Leipzig, who leads the Foundation’s Center of Excellence in Geriatric Medicine at Mount Sinai School of Medicine in New York, is a long-time Foundation grantee and a national leader in geriatrics education working also with stakeholders such as the Donald W. Reynolds Foundation and the American Board of Internal Medicine.
In her piece, Dr. Leipzig crystallizes our concerns about the current quality of care for older adults, through an all too common example of poor care. She also describes the progress that has been made to identify the required basic competencies for health professionals to do better. Finally, she makes some excellent public and educational policy recommendations to achieve that competence.
Please share Dr. Leipzig’s article widely with those who are interested in care of older people. Even more important, please share it with those who should be interested but aren’t yet. I believe that this piece can explain in a nutshell what we all mean when we talk about the urgent need to improve the quality of geriatric health care.
The Patients Doctors Don’t Know
By ROSANNE M. LEIPZIG
Published: July 1, 2009AS they do every July, hospitals across America are welcoming new interns, fresh from medical school graduation. Given how much these trainees have yet to learn, common wisdom holds that it’s not a good time of year to get sick. This may be particularly true for older patients, because American medical schools require no training in geriatric medicine. . . . more
More information on the projects mentioned in the opinion piece can be accessed through the links below:
- The Institute of Medicine’s Retooling for an Aging America: Building the Health Care Workforce.
- The Hartford/AAMC graduating medical student “Don’t Kill Granny” competencies.
- POGOe: A wide variety of educational methods and tools to help health professionals achieve competence in care of older adults.
Corinne Rieder, EdD says:
July 8th, 2009 at 11:56 pm
While we were very pleased by Dr. Leipzig’s OpEd, there is always more to a story. Corinne Rieder, the Foundation’s Executive Director, sent the following letter to the New York Times to add a few points to the story.
To the Editor:
All doctors, as well as other health professionals, should be required to master the geriatric competencies and skills appropriate to their professions that Dr. Leipzig outlines and the Institute of Medicine recommends (“The Patients Doctors Don’t Know,” July 2).
But good geriatric care is also team care and reform efforts must reflect this if we are to improve patient quality and reduce health care costs. In addition to each health profession mastering individual disciplinary competencies, physicians (specialists and primary care providers), nurses, social workers, pharmacists and others must learn to share responsibility for care with each other and with the patient/family. They must share information in an efficient and timely manner, stay coordinated on a common plan of care, and delegate work and responsibility to the best-suited team member. Most important, health professionals need to keep in mind that patients and their families are the captains of their team and it is their preferences and goals that should give overall direction to care.
Corinne H. Rieder
Executive Director and Treasurer
The John A. Hartford Foundation
55 E 59th Street
16th Floor
New York, NY 10022-1713
Christopher Langston, PhD says:
July 9th, 2009 at 12:07 am
To the Editor:
Doctors and other health professionals do indeed lack essential competencies to deliver high quality care to older adults with complex health care needs. (“The Patients Doctors Don’t Know,” July 2).
However, for older adults to actually receive the quality care they deserve and we all want for our parents and grandparents, the way health care is organized and financed also needs an upgrade. Already, doctors can’t fit the needs of frail older adults into the standard 11 minute office visit, so skills like diagnosing dementia and communicating complex prognoses to family members go to waste, unused. Until health care professionals can adjust their services to the needs and complexity of the patient and get paid appropriately, we risk teaching future doctors more skills that they still won’t be able to use in real practice.
Christopher A. Langston, PhD
Program Director
The John A. Hartford Foundation
55 East 59th Street
New York, NY 10022
Chris Langston says:
July 31st, 2009 at 3:52 pm
I saw this as KevinMD.com – a medical blog I’ve heard good things about – http://www.kevinmd.com/blog/2009/07/should-geriatrics-be-mandatory-in-medical-school.html – Chris
“Should geriatrics be mandatory in medical school? July 15, 2009″
“Generally, all third-year American medical students rotate in medicine, surgery, OB/GYN, pediatrics, and psychiatry.”
“Should geriatrics be added to that list?”
“After all, patients aged 65 years and older make up more than 40 percent in medical specialty care, and over 30 percent in surgical care. For instance, heart attacks present differently in the elderly, and confusion can be due to infection or a drug reaction.”
“Most doctors do not receive formal training in geriatrics, and as geriatrician Rosanne M. Leipzig writes, “Often even experienced doctors are unaware that 80-year-olds are not the same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and difficulty breathing; an 80-year-old with the same illness may have none of these symptoms, but just seem ‘not herself’ — confused and unsteady, unable to get out of bed.”
“I was lucky that, at Boston University School of Medicine, geriatrics was a required course during the 4th year of medical school.”
“Perhaps more medical schools should follow that lead.”
*
*
*
Amen we say at JAHF. And we note that Boston University *is* also a Hartford Foundation Center of Excellence in Geriatric Medicine and Training and a strong institution in geriatrics at the medical school, residency, and fellowship levels of training. For more information see, http://www.bmc.org/geriatrics/education.html