TY - JOUR
T1 - Are we on the same page?
T2 - Exploring the role of the geriatrician in the care of the older surgical patient from the perspective of surgeons and geriatricians
AU - Howie, Sarah
AU - Tinker, Anthea
PY - 2018/10/1
Y1 - 2018/10/1
N2 - There is increasing recognition that the ageing population represents a challenge to existing surgical services. National reports recommend that geriatricians proactively review older surgical patients to improve care and outcomes. However, this approach has not been widely translated into practice. A qualitative study was conducted using 12 semi-structured interviews of surgeons and geriatricians to explore the role of the geriatrician in the care of older surgical patients. Participants agreed that the current system did not meet the needs of older surgical patients. Geriatricians valued their holistic way of working but these generalist skills can overlap with other specialties, seen by some as wasting resources. Three models of care were proposed, with the ownership and location of the patient as well as the role of education being the key variables. The main obstacle preventing integrated working was the concern of de-skilling the surgeons, narrowing their role to that of a 'technician'. Other barriers included loss of autonomy; lack of evidence; and a lack of recognition of the need for a geriatrician. There is acceptance that closer working practices are necessary to meet the needs of this complex patient group but a lack of evidence, together with significant human factors, are challenges that must be addressed to realise this aim.
AB - There is increasing recognition that the ageing population represents a challenge to existing surgical services. National reports recommend that geriatricians proactively review older surgical patients to improve care and outcomes. However, this approach has not been widely translated into practice. A qualitative study was conducted using 12 semi-structured interviews of surgeons and geriatricians to explore the role of the geriatrician in the care of older surgical patients. Participants agreed that the current system did not meet the needs of older surgical patients. Geriatricians valued their holistic way of working but these generalist skills can overlap with other specialties, seen by some as wasting resources. Three models of care were proposed, with the ownership and location of the patient as well as the role of education being the key variables. The main obstacle preventing integrated working was the concern of de-skilling the surgeons, narrowing their role to that of a 'technician'. Other barriers included loss of autonomy; lack of evidence; and a lack of recognition of the need for a geriatrician. There is acceptance that closer working practices are necessary to meet the needs of this complex patient group but a lack of evidence, together with significant human factors, are challenges that must be addressed to realise this aim.
KW - Collaborative care
KW - High-risk surgery
KW - Older patient
KW - Orthogeriatrics
KW - Surgical liaison
UR - http://www.scopus.com/inward/record.url?scp=85054452697&partnerID=8YFLogxK
U2 - 10.7861/clinmedicine.18-5-374
DO - 10.7861/clinmedicine.18-5-374
M3 - Article
C2 - 30287429
AN - SCOPUS:85054452697
SN - 1470-2118
VL - 18
SP - 374
EP - 379
JO - Clinical Medicine, Journal of the Royal College of Physicians of London
JF - Clinical Medicine, Journal of the Royal College of Physicians of London
IS - 5
ER -