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VA Puget Sound Healthcare System, University of Washington, Seattle
William R. Hazzard, Director, Geriatrics and Extended Care, VA Puget Sound Healthcare System, University of Washington, S-GEC-182, 4660 S. Columbian Way, Seattle, WA 98108 E-mail: william.hazzard{at}med.va.gov.
IN his provocative thought-piece, Dr. Kane suggests that geriatrics is at a crossroads (1). He does acknowledge that attempts have been made to "gerontologize" other fields of medicine but suggests that geriatrics has now reached the point where the next stage in its journey requires redirection to a focus on chronic disease as its defining niche.
From my perspective, however, for geriatrics to move forward would not entail redirection but simply reinforcement of our determination to disseminate widely our traditional expertise in chronic disease and related domains—including frailty and other geriatric syndromes. Our geriatric diaspora should spread ever more widely and become integrated as seamlessly as possible into all of internal medicine and family practice, surgery and its subspecialties and allied disciplines, neurology and psychiatry, rehabilitation, and beyond—in short, throughout medicine and the many other health care disciplines engaged in care of the elderly population, all in the interest of improved care of the burgeoning numbers and progressive aging of elderly Americans. The prospect of providing that care in an appropriate and cost-effective manner threatens to overwhelm our health care system unless anticipatory changes in education, training, and research are made now and in the near future. However, effectively meeting this demographic imperative both qualitatively and quantitatively also represents the future of our profession. Thus geriatrics represents an opportunity for all the specialties and subspecialties to flourish in the 21st century.
Thus I would argue that rather than standing at a crossroads, we in geriatrics are simply still rather early in our journey toward our necessary position of leadership in medicine, still in the lag phase of what is certain to become logarithmic growth and development for several decades to come. As pointed out by Dr. Kane, we must overcome the disincentives, disinterest, denial, and many other barriers to our progress that are so widespread both within medicine and also in the "ageist" world at large, challenges that might discourage all but the most dedicated, determined, and optimistic among us.
Yet there are unmistakable signs of progress in our journey toward respect, recognition, and positions of leadership and responsibility. Yes, the number of certified geriatricians continues to decline as many "grandfathers" elect not to be recertified. However, those that do are clearly dedicated and competent, and all those certified since 1994 are not only committed to excellence in care of the elderly population but also have actually been trained to practice expert geriatrics. The quality of our national meetings improves year by year. The sophistication and results of our research are receiving recognition, and competition for funds from the National Institute on Aging becomes keener each year. Our leading journals are becoming more selective as the quality of submissions improves (2). Finally, those who choose geriatrics clearly recognize and embrace their role as ambassadors, pioneers, and pacesetters; these are forward-looking physicians whose contributions as academic and community leaders will be leveraged many times over through those whom they teach by precept and personal example throughout long and satisfying careers.
So I would urge us as geriatricians of the present and future to press on with our journey along the path we are already embarked upon—to "gerontologize" medicine and our partner health professions in the interest of excellent care of our older citizens.
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This article has been cited by other articles:
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  J. E. Morley Editorial: Hot Topics in Geriatrics J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M30 - 36. [Full Text] [PDF]
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D. R. Thomas Letters to the Editor: The Future History of Geriatrics: Consulting the Experts J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2003; 58(1): M92 - 92. [Full Text] [PDF]
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