Reflecting on 50 years of geriatric medicine
By Dick Sainsbury
“And what’s more, if you don’t improve, I’ll send you to the K wards (geriatric medicine rehab) to work”, were the words used by an old ward sister, very publicly, to a nurse she was admonishing for poor performance in 1982. I record this incident in my recently published book, All Experience is an Arch, as an example of the negative attitudes towards our specialty that we often encountered in those days. There were also labels such as ‘bed blocker’, ‘social admission’ and ‘acopia’ which were equally pervasive. Educating people against negative attitudes to older people was an important function for early geriatricians and although great improvements have been made, we must be ever vigilant as ‘the jungle can close in at any time’.
The 1970s and 1980s were also the times when geriatric medicine was trying to establish its niche, or even whether it was required, as a separate discipline to general medicine. Most of the few geriatricians in Australasia at the time had completed part of their training in the United Kingdom and had absorbed the principles of the pioneer Marjory Warren and her successors. It was also a time of sub-specialisation in general medicine which began firstly with cardiology with the advent of coronary care units. At the same time some units in the United Kingdom, notably Hastings and Hull were running age-related services where all medically ill people in the region were admitted under the geriatric medicine service. Some general physicians were concerned that geriatric medicine was going to usurp the traditional role of general medicine and this led to some, at times acrimonious discussions. Gradually these matters resolved as the enthusiasm for age-related services waned and most geriatric services became ‘needs-related’ with an emphasis on rehabilitation, restoration of function and community outreach. The former ASGM, NZGS and IMSANZ can take credit for negotiating these issues. Among the positives to emerge is the larger number of advanced trainees in both disciplines who can participate both in geriatric medicine and on the acute medical roster.
I have mentioned some of the earlier personalities in New Zealand geriatric medicine in the History of the New Zealand Geriatric Society (NZGS) that I have written for the ANZSGM website but I would like to acknowledge the late Professor John Campbell in particular. John led research in New Zealand. He gained international recognition of his work on Fall epidemiology and prevention and his earlier Gisborne community study. He served a period as Chair of the Medical Council of New Zealand and his advice was regularly sought by the Department of Health in policy making. Sadly, he died after a rapidly progressive illness in 2016.
The increase in advanced trainees is particularly satisfying. Few were attracted to geriatric medicine in the early 1980s. The new generation are carrying forward the torch of research. This is reflected in the high standards of ANZSGM scientific meetings and the continuing rise in the quality of publications.
As I look back, I can appreciate the advances that have been made. I see the specialty as being in very good heart and I look forward to continuing participant. I am also confident that good services await me should I become a consumer.
Dick’s book “All Experience is an Arch” is available by contacting Dick directly at dsain@xtra.co.nz for $NZ25 plus postage or for those in New Zealand it is available through NZ Booksellers ltd of Oxford NZ.
