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The Geriatric Practice
Choosing a physician for the elderly.
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Two years ago I switched the sweet (almost) 103 year old to a geriatric specialty practice. The specialty of geriatric medicine is a relatively new one. When a person hits seventy plus, it's time to consider switching to a geriatric specialty practice. This is not to say that your family physician is incompetent, but what people see a lot of they get good at, and the geriatric practices are good at what they do. The elderly and the stroke-disabled have special needs, different norms for lab results and medications, and the geriatric physician has that know how. The one we use is affiliated with a medical school and they provide me with a print out of all her labs without asking and e-mail me once a week to inquire as to her well-being. One of the biggest benefit of such a practice is that they maintain a special geriatric ward for the super-elderly and have a procedure to bypass the emergency room when, for example, an IV for hydration is necessary. As you get up in years your family physician will probably be retiring and turning his practice over to a youngster. That would be a good time to consider a switch to a geriatric specialist in a geriatric practice. The difference in attitude between a general practice physician in the ER doing his internship and a specialist in geriatric care is significant. The geriatric specialist is far less likely to "give up" and to talk you into a DNR, for example.
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I might ad, in this case, the practice is a few steps away from the hospital emergency room. For the elderly they have an "emergency appointment system" that essentially enables you to call and immediately be evaluated by a geriatric specialist, bypassing the ER, but with the ER available (as well as the ICU), if necessary. The difference is the geriatric unit has a comfortable area less threatening and frightening than the ER (which is a madhouse, as are most ER's in busy areas), and the elderly patient can remain there for extended treatment and potential admission as far less cost that the ER. In addition, the elderly should not have excessive blooods drawn, and the geriatric unit keeps this to a minimum, whereas the normal ER requires these tests as a matter of protocol. Because this is a teaching hospital during every visit the elderly patient is examined by at least two physicians. A physician in training (or more than one) and a senior physician instructor. If nothing else, two heads are always better than one.
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