BLOG: Scotland and Italy, a different approach in Medicine of the Elderly

by Kenneth Newell | Visiting Trainee in Medicine of the Elderly, Genoa

As I finish my Observership at the Royal Infirmary Hospital in Edinburgh, I gather my thoughts about how different an approach can be about the same matter.

I’m in the middle of my Speciality Training in Medicine of the Elderly (MoE) in Italy, and a strong desire to see how Geriatrics is done on the other side of the pond brought me here. The main idea was to understand OrthoGeriatrics, as most of the guidelines come from this country, but thanks to great work of Dr Alixe Kilgour and Professor Susan Shenkin, I was able to see the full extent of the MoE services in Midlothian, in just 12 weeks that flew by.

Edinburgh has a great knowledge in how to approach elderly patients, a true commitment in shifting the model from a pure age-based one to a more frailty-based, not tied only to the age of the patient. The extensive use of guidelines, and the accessibility of these resources through a wonderful intranet makes it seem, at least for somebody from the outside like me, that the working life is more structured, easier to approach in a sense. Everything got its rhythm, properly organized. The setting for the so called Silver Patients here is thoroughly set up, and goes through every facet of the hospital, from the ED Frailty team to the wonderful work done by Hospital @ Home, a true staple and example on the matter for everybody interested. This is one of the first aspects where I saw a major difference: a real connection between hospital and territorial services, with an organization that makes it possible to send patients home faster, thanks to a great team that can manage the most common problems (like pneumonia, or heart failure) at residence, offloading the pressure in the hospital.

Unfortunately, there is a stark difference from how territorial services works in Italy, behind in terms of organization, staff available and future programming.
At the same time, the MoE team not only showed me how they work, but also how they talk to patients, in an attempt to really put them at centre of the care plan, truly trying to have them make conscious decisions for their wellbeing, but also for what they wish for themselves. That’s another aspect that is very different from Italy, as we still navigate a space where medicine has a more paternalistic approach, obviously not always, but it’s a cultural heritage that is still much common in many places, while the UK approach is something we can really learn from, as much it can be time consuming at times.

Being also able to peak in the academic world was also very interesting, understanding how the approach to data gaining and paper production is much more intertwined with the daily life of a doctor, at least in the University hospitals.

Scotland has been very good to me, and this Observership thought me much more than just on the professional level, but also on the human side, as I was enabled to learn and understand quickly and easily how people work here and how it is approached in a completely different environment and culture compared to where I’m from.

What I wish to bring when I come back, other than pure notions (that are always useful), is this sense of purpose I felt in Geriatrics, that really helped shine a new light for the argument and a desire to bring the best of both world now that I’m home.