BLOG: Reflections on geriatric care during an Edinburgh observership

by Dr Ian Perera, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Poland

Walking into the Acute Medical Unit was formidable. I passed bay after bay of patients on our way to our next consultation, with alarms seemingly going off in every corner. Staff nimbly shifted through the corridors in all directions in packs, while patients regularly flowed in and out rooms, curtains opening and closing behind them.

It was my first day at the Royal Infirmary of Edinburgh as part of an observership on how geriatrics is practiced in Scotland. I was looking for insights on how to improve geriatric care back in my hospital in Krakow during my two weeks here. We reached the corner of a bay to find an older woman receiving oxygen lying in bed with significant swelling of her lower limbs. The consultant knelt next to her and introduced himself, speaking slowly and clearly, and an atmosphere of calm descended. The woman replied slowly, in gasps, and the consultant listened intently. I looked over to the whiteboard over her bed, where her name was filled in and, surprisingly to me, how she likes her tea. After the consultant finished examining her, he shared his thoughts with the woman and negotiated his plan with her. She smiled weakly, grateful for the interaction and clarity in her care plan.

I appreciated these moments of humanity throughout my stay. I rotated across multiple hospitals and settings across Edinburgh, from inpatient services to hospital-at-home and the day hospital. I saw patients in various states, from the woman mentioned earlier, to an older man experiencing delirium wandering across a hospital ward, to a lady at home trying to manage her shortness of breath. Regardless of the physician or the setting, the patients they interacted with were treated with dignity regardless of whether they were fully able to comprehend the magnitude of what was happening to them. They lent sympathetic ears to caregivers as well, later working with social workers in multidisciplinary team meetings to establish needs and support. Other medics chipped in and shared their insights, from occupation therapists to nurse practitioners. The importance of these multidisciplinary interactions highlighted the strengths of each discipline and how their complementary skills can reap major benefits for the patients that they work with. I also got to listen to their stories on how they came to work with older adults, what brings them satisfaction and what occasionally frustrates them. While no system is perfect, the people that are part of it make all the difference. Thanks to Professor Susan Shenkin I was able to see the broad spectrum of geriatric care available for older adults in Scotland and met several wonderful medics along the way. It led to many moments of reflection on how simple changes have the potential to significantly impact people’s lives.

Additionally, I gained an insight into aspects of academic medicine during my stay. I was invited to participate in the Ageing & Health Research Update meeting hosted at the Usher Institute of the University of Edinburgh, where I learned about the latest developments in ageing research, and delivered a short talk on geriatrics in Poland and its relationship to the PROGRAMMING COST Action 21122. Following this I was offered the opportunity to converse with Prof. Alasdair MacLullich and was inspired by how he was able to affect change through his research with persistence and determination. I was also afforded the chance to attend the European Alzheimer’s Disease Consortium meeting in Edinburgh hosted at the breathtaking Playfair Library, where I listened to the latest developments in dementia research and got to connect with experts on the topic. 

I left Edinburgh full of inspiration for what geriatric medicine can achieve. Despite the pressures of interacting with complex patients with numerous needs occasionally being overwhelming, I experienced the value of sharing those experiences in a team. While it is a long road for us to reach what has been accomplished in Scotland, our team has been inspired to make small key steps to improving patient care. 

Acknowledgement

The observership was funded by Jagiellonian University Medical College, project number N41/DBS/001463. The attendance for the European Alzheimer’s Disease Consortium was funded by the Alzheimer Scotland Dementia Research Centre.