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Wednesday, November 25, 2009

By 2030, we will need 36,000 geriatricians.

Caring for the elderly - The Boston Globe
Geriatric medicine cuts across all diseases that contribute to the functional problems an older adult might have. An older patient typically goes from one specialist to another, with each doctor treating a single problem, but often not looking at the patient as a whole. The patient may receive treatment, but quality-of-life goals are rarely discussed.

In contrast, the geriatrician often sits with three (or more) individuals: the patient, the patient’s spouse, and an adult child. Together they present a medical history and, often, a list of medications prescribed by different doctors. Medicare pays the geriatrician a small fraction of the true cost spent with the patient, taking a history, examining the patient, ordering appropriate tests, making a diagnosis, and developing a treatment plan. Following the visit, the geriatrician reviews laboratory studies, talks to family members and other doctors, organizes rehabilitative and social services, completes applications for supportive housing, renews medications . . . and gets paid nothing for this work.

Ironically, geriatricians actually save health care dollars by planning ahead; avoiding unnecessary hospitalizations, tests, medications, and treatments; reducing hospitalization and surgical complications; shortening lengths of stay; and facilitating the safe transfer of patients to appropriate rehabilitation settings and care at home. President Obama’s health care bill would, at least, require Medicare to cover counseling sessions so that physicians can develop appropriate care plans with their elderly patient