In a series focusing on medical specialisms, Dr Mary Britton talks about geriatrics.
Dr Mary Britton cares for the elderly
Geriatric medicine is a branch of general medicine concerned with all aspects of illness in the elderly, from prevention and treatment through to dealing with the social effects of disease.
Older people have higher rates of illness, respond more slowly to treatment, and may demonstrate a different pattern of symptoms. All this requires specialist skills from a doctor.
WHAT IS YOUR JOB?
I am a consultant in general medicine and elderly care at the Homerton University Hospital, London.
I specialise in dealing with the type of problems people get in old age.
We generally get people from their late 70s through to their 90s, although I would take younger patients with things like dementia, Parkinson's disease, or who have had a stroke.
WHAT IS THE MOST COMMON CONDITION?
We often deal with people who have had falls, and who have problems with their mobility, which can make living at home difficult.
We also regularly see people with cognitive (thinking process) problems, or incontinence.
Other conditions we deal with on a regular basis include Alzheimer's disease, atherosclerosis (thickening of the arteries) and other cardiovascular problems in their final stages.
Our patients tend to stay longer with us because I also deal with rehabilitation, so an average stay could be as long as 20 days.
WHAT IS THE MOST COMMON PROCEDURE?
Caring for broken bones.
It is more common for the elderly to fall and because it is also more common for them to have osteoporosis they tend to break their bones more easily.
If they do have a break this is most likely to be the neck or the femur (leg bone).
THE HARDEST THING ABOUT YOUR JOB?
One of the hardest things about getting older is balancing your risks against your desire to live independently.
Part of my role is to advise the relatives and carers of an elderly patient about how to strike the best balance to maximise their happiness without putting them at unnecessary risk.
THE MOST SATISFYING CASE?
One of the most satisfying things I can do is to give somebody their mobility back if they can't walk.
Of the specific cases I have dealt with, the most satisfying was a 92 year-old lady with cancer of the colon.
She was very anaemic and not sure that she should have an operation - she thought 'what is the point?'.
But she had no other illness, and I thought that there was a point, and I talked to the other people involved.
She had a rough time, but after a month she started to get better.
When I saw her in a clinic two years later she was hale and hearty and enjoying her birthday.
WHY DID YOU CHOSE THIS SPECIALITY?
I like to treat people in a holistic way, not specialising on one particular organ, but looking at the body as a whole.
If one thing goes wrong in an elderly person the whole pack of cards can fall down and everything can start to go wrong, causing a crisis of confidence, not just for them, but their carers as well.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALITY?
I would feel frustrated in more specialised jobs. I enjoy working with the elderly.
I find them a fascinating group of people to work with.
And when you have treated them they are grateful. I know that is a selfish reason and it is not the reason for treating somebody, but it is nice when people are grateful.
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
As the population is ageing I think the role of geriatrician will become less and less attached to the acute hospitals and more and more based in the community.
I think we will spend more and more time working with the community nurses and the GPs as the needs become more community based.
CV - Dr Mary Britton
1981: Qualified as a doctor
1982-3: Senior house officer in accident and emergency, Royal Liverpool Teaching Hospital
1985-6: Registrar general medicine, King George Hospital, Ilford, Essex
1993-96: Senior Registrar general and geriatric medicine, St Thomas' Hospital, London and Kent and Canterbury Hospital, Canterbury
1997-8: Locum consultant physician with interest in diabetes/endocrinology, at Treliske Hospital, Truro, Cornwall
1998-present: Consultant physician in geriatric and general medicine at the Homerton University Hospital, London