Young Doctors Get Nudge to Consider Capabilities, Problems of Older Adults
Theresa Tighe Of the Post-Dispatch, St Louis Post-Dispatch (MO)
To the six white-coated medical students standing around a patient's bed at St. Louis University Medical Center, the diagnosis seemed simple:
This 76-year-old man who saw yellow halos around their heads and smelled poison gas coming from the pictures on the wall had lost his mind.
But their professor, geriatric psychiatrist George Grossberg, said no. At the root of the man's hallucinations: a dose of heart medicine - digitalis - that would have been no problem in a younger patient but that can produce delirium in the elderly. Lower the dose, and the man's mind would clear completely.
Such lessons are the reason some doctors say medical schools need to make training in geriatrics mandatory.
Even though the elderly constitute the most rapidly growing part of the population, some schools still offer only tidbits about geriatrics, said Grossberg, head of the geriatric psychiatry division at St. Louis University.
In 35 years, one in five Americans will be 65 and older. Older patients often differ physically, psychologically and socially from younger patients and need special treatment. But in the United States:
- Only one medical school, Mount Sinai School of Medicine in New York, has a department of geriatrics.
- Only 11 percent of the 126 medical schools responding to a survey by the Liaison Committee for Medical Education in 1992 taught geriatrics as a separate required course.
- Only 2.9 percent of medical school graduates in 1992 took an elective course in geriatrics, according to the American Medical Association.
Locally, St. Louis University requires medical students to spend four weeks in geriatric training. Neither Washington University nor the University of Missouri at Columbia requires training in geriatrics. Both schools weave information about older patients into required lectures.
Geriatrics is a relatively new discipline. Only in the last five years have doctors been able to take examinations in geriatrics through the American Board of Internal Medicine, the American Board of Family Practice and the American Board of Psychiatry and Neurology.
Part of the problem is the lack of doctors trained to teach geriatrics.
About 2,000 doctors in the United States are qualified to teach geriatrics. It would take triple that number to teach geriatrics adequately in medical schools, and in 1992, no one applied for more than one-third of the nation's geriatric fellowships, according to a study by Dr. …