Why geriatric medicine, and what have you done that evidences that commitment?

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The moment that decided it was an 88-year-old woman admitted after two falls whom the take had labelled as a social admission. A proper comprehensive geriatric assessment found postural hypotension from three antihypertensives, an anticholinergic burden that explained her confusion, undiagnosed osteoporosis and a hearing aid that had not worked for a year. She went home walking with a frame and did not come back for eighteen months. What struck me was that the intervention was diagnostic and technical, not simply kind, and that CGA is a skill you have to learn rather than an attitude you adopt. I have built on that deliberately. I did a taster in the frailty SDEC and the orthogeriatric service eighteen months ago, which showed me the front-door half of the specialty. I then led a QI project on anticholinergic burden at discharge across 140 patients over 75, using STOPP/START at the board round with a structured medication review template; the mean anticholinergic burden score fell from 2.4 to 1.3 and it has held for eight months because it is now embedded in the ward round proforma. That was presented at the regional BGS meeting in April. I have also taught the foundation doctors' delirium and 4AT session for four terms, and I have been a BGS trainee member for two years. What I find hardest is the discharge process — watching a patient who was medically ready lose function over three weeks waiting for a package of care — and that frustration is precisely what I want to work on, through Red2Green and discharge-to-assess pathways. My direction is orthogeriatrics or perioperative medicine for older people, though I want the breadth of training first.

Why Geriatric Medicine, and What Evidences It?

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