SECOND OPINION
We know medical students are ‘turned off’ by geriatric medicine, perceiving the specialty as having low prestige and earn- ing potential. A recent survey of medical students showed just 6% are seriously con- sidering taking a job in this area.1
Yet the
reality is that due to our ageing population, most of them will be working principally with older people during their careers.
These ageist and outdated attitudes need to be challenged as people begin their train- ing to work in the NHS. Yet there is plenty of evidence to show that the training many health professionals receive actually rein- forces the general attitude that older peo- ple’s medicine is a ‘second class’ specialism and does not require the same prominence in pre-registration training as other areas.2
It is essential that pre-registration courses are rebalanced so that working with older patients and geriatric medicine becomes a core part of every professional’s training, rather than a rare specialism of a small mi- nority.
Ageist attitudes among staff are harder to change and will take time. Training and professional development is key to instilling in all staff the values of dignity and respect, which are so important to older patients. In particular, complaints and patient feed- back need to be fully incorporated into staff appraisals to make people accountable for their actions and ensure these soft skills re- lating to patient interaction are recognised and valued.
The equality legislation has finally put in place the legal framework to make any kind of age discrimination illegal, but providing
the support to ensure this is properly im- plemented is key to its success.
There also needs to be a fundamental shift in the way the NHS is organised to reflect the multi-faceted needs of patients today. The NHS can be very disjointed and bu- reaucratic, with consultants leading differ- ent departments focused on one speciality.
This can work well if you are suffering with just one illness, but as many older people will arrive at hospital with multiple condi-
Health Ombudsman’s case study: Mr D’s story
Mr D was first admitted to the Royal Bolton Hospital NHS Foundation Trust with a sus- pected heart attack and discharged a week later with further tests planned on an out- patient basis. Four weeks later, Mr D was readmitted with severe back and stomach pain.
He was described by clinicians and nurses at the hospital as a quiet man, well-liked, who never complained or made a fuss.
Mr D was diagnosed with advanced stomach cancer. His discharge was brought forward to 27 August, the Saturday of a bank holiday weekend. On the day of discharge, which his daughter described as a ‘shambles’, the family arrived to find Mr D in a distressed condition behind drawn curtains in a chair. He had been waiting for several hours.
16 | national health executive Mar/Apr 11
He was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow.
The emergency button had been placed be- yond his reach. His drip had been removed and the fluid had leaked all over the floor, making his feet wet.
When the family asked for help to put Mr D on the commode he had ‘squealed like a piglet’ with pain. An ambulance booked to take him home in the morning had not ar- rived and at 2.30pm the family decided to take him home in their car.
On arriving home, his family found Mr D had not been given enough painkillers for the weekend. He had been given two bot-
tles of morphine in an oral solution, which was unsuitable as he was unable to swal- low. The family spent much of the weekend trying to get prescription forms signed and permission for district nurses to adminis- ter morphine in injectable form.
Mr D died, three days after discharge, on the following Tuesday.
His daughter described her extreme dis- tress and the stress of trying to get his medication, fearing he might die before she got home. She lost time she had hoped to spend with him over those last few days.
Mr D’s daughter complained to the trust and the Healthcare Commission about very poor care while in hospital, then turned to the Ombudsman.
tions not fitting into any clear pathway, this can make it very difficult to get the help you need. For example, an older patient living alone, suffering with diabetes, impaired vi- sion, diabetic wounds, immobility, bowel cancer and social care needs could be in- teracting with four separate services.
This results in a huge amount of crossover and repetition that treats the patient as a collection of conditions rather than taking a person-centred approach to what is best for them.
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