programs in adult primary care medicine have
plummeted, while fields like plastic surgery and
radiologyreceiveapplicationsinrecordnumbers.Partly,
this has to do with money—incomes in geriatrics and
adult primary care areamong the lowest in medicine.
Andpartly,whetherweadmititornot,alotofdoctors
don’t like taking care of the elderly.
“Mainstream doctors are turned off by geriatrics, and
that’sbecausetheydonothavethefacultiestocopewith
the Old Crock,” Felix Silverstone, the geriatrician,
explainedtome.“TheOldCrockisdeaf.TheOldCrock
has poor vision. The Old Crock’s memory might be
somewhatimpaired. Withthe Old Crock, youhave to
slowdown,becauseheasksyoutorepeatwhatyouare
sayingorasking.AndtheOldCrockdoesn’tjusthavea
chief complaint—the Old Crock has fifteen chief
complaints.Howintheworldareyougoingtocopewith
allof them?You’re overwhelmed.Besides, he’shad a
numberofthesethingsforfiftyyearsorso.You’renot
goingtocuresomethinghe’shadforfiftyyears.Hehas
high blood pressure.He has diabetes. Hehas arthritis.
There’snothingglamorousabouttakingcare ofanyof
those things.”
There is, however, a skillto it, a developed body of
professionalexpertise.Onemaynotbeabletofixsuch
problems,butonecanmanagethem.AnduntilIvisited
myhospital’sgeriatricsclinicandsawtheworkthatthe
clinicianstheredo,Ididnotfullygraspthenatureofthe
expertiseinvolved,orhowimportantitcouldbeforallof
us.