Wednesday, July 8, 2009

The Importance of Teaching Doctors About Geriatrics

As 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. [1]

This was the conclusion of a doctor and professor at Mount Sinai School of Medicine in a recent editorial in the New York Times.

Dr. Rosanne Liepzig had the courage to speak out about this serious problem. She was part of a group of doctors that recently published a report in the Journal of Academic Medicine setting forth some minimal abilities that they believe medical students should demonstrate before caring for elderly patients. The group jokingly nicknamed the report the “don’t kill granny list.”

According to Liepzig, even experienced doctors often do not appreciate the differences between a 50 year old patient and an 80 year old patient. Diseases such as pneumonia may have entirely different symptoms in a younger patient than in an elderly patient. Medication dosages for a senior may need to be 50% lower than for a patient in her 50s. The effects of lost functional mobility may also be underestimated by physicians with no training in geriatric medicine.

This gap in medical training is especially surprising given the number of geriatric patients. According to Liepzig, geriatric patients make up 48% of all inpatient hospital days and 32% of the average doctor’s workload in surgical care.

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….” [2]

Liepzig also points out that Medicare contributes more than $8 billion dollars a year to support residency training, yet it does not require that part of that training focus on geriatrics. [3]

The Institute of Medicine reached similar conclusions in their 2008 report titled “Retooling for an Aging America.” That report concluded that all licensed health care professionals should be required to demonstrate competence in the care of older adults.

There is no question that our population is aging. The only question is when the medical establishment will start training doctors to care for them.

You can read the full text of Dr. Leipzig’s article at

[1] The Patients Doctors Don’t Know. OpEd by Dr. Rosanne Leipzig. July 1, 2009. New York Times.
[2] The Patients Doctors Don’t Know. OpEd by Dr. Rosanne Leipzig. July 1, 2009. New York Times.
[3] The Patients Doctors Don’t Know. OpEd by Dr. Rosanne Leipzig. July 1, 2009. New York Times.

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