Young geriatricians are waiting for you in Switzerland!

Urgently needed: young doctors for elderly patients

Jeannie Wurz, Swiss NewsTranslation and adaptation: Igor Petrov

People in developed societies are living longer and longer, and therefore the demand for medical personnel specializing in geriatric problems, that is, diseases faced by patients in old age, is becoming more and more significant. The problem is that, compared to neurosurgery or cardiology, geriatrics is still not so attractive for medical students.

The University Clinic of Bern, also known as "Inselspital", can be seen from afar. Against the background of a generally low-rise city, the high-rise building of the main building of the clinic looks just like a huge skyscraper. Inselspital is one of the largest clinics not only in Bern, but throughout Switzerland. This is a real "health factory", and its heart is undoubtedly the intensive care unit. Something is constantly happening here, here, like nowhere else, you can feel the tense rhythm that the clinic lives with: automation works everywhere, specially trained medical staff monitors the situation on computer monitors, nurses change bandages for patients...

Three times a day, during the shift shift, the clinic makes a detour: a group of doctors moves from bed to bed, doctors entering the service receive the latest and up-to-date information about the condition of patients. In total, the intensive care unit of the Inselspital clinic is designed for 51 people. On average, 40 to 45 patients are here every day. Stefan Jakob, the chief physician of the department of "IIMC" ("InterdisziplinAre Intermediate Care") tells us about this. In this department, patients are under special supervision on their way from the intensive care unit to a regular ward. As Sh emphasizes . Jacob, the average age of such patients is constantly growing.

"Ten years ago, the average age of our patients barely crossed the 60–year mark," he says. "Today, this indicator is at the level of 65 years, and the spread by age can be very large, reaching even 90, or even 95 years. Therefore, today we are increasingly faced with the need to perform surgical and other interventions for reasons that in the past were hardly observed in elderly and very elderly patients. We are talking, for example, about transplants, about interventions in connection with strokes, heart transplants. In addition, older patients stay with us after operations longer than younger ones. And that is why we will need additional beds soon."

The needs of an aging populationMany problems characteristic of the elderly begin in patients at a time when they themselves are not yet aware of themselves as old people.

However, already at the age of 50, one out of five Swiss residents already suffers from a couple of chronic diseases of the so-called senile spectrum. Such data was recently provided by the Research Institute "Swiss Observatory of Health" ("Schweizerisches Gesundheitsobservatorium"). As of 2012, one fifth of patients in Swiss general clinics were between the ages of 75 and 84. In the UK, this trend is even more pronounced. There, the average age of clinic patients has long been at the level of 80 years.

Caring for elderly patients requires special knowledge and skills of physicians. Thomas Munzer, chairman of the "Swiss Specialized Society of Geriatrics" ("Schweizerische Fachgesellschaft fur Geriatrie") and chief physician of the University Clinic in St. Gallen, draws attention to this. "Such people suffer from three or even five medical problems at once, and each of these problems needs careful care. And for this, in turn, it is necessary to have knowledge in the field of age biology, and it is necessary to understand that an elderly organism functions differently than a young one," T. Munzer emphasizes.

Training of specialist doctorsAndreas Stuck, the chief physician of the geriatric department of the Inselspital clinic agrees with this, but he emphasizes that such knowledge does not come from nowhere, that they need to be mastered and very actively.

According to him, young doctors specializing in diseases of age should, first of all, understand how and what diseases manifest themselves in the body of elderly patients, what "signals" there are here and how they need to be recognized and interpreted.

In addition, ethical issues should not be underestimated, for example, what priorities should be chosen in the treatment of patients aged 90 years and even more, "whether active therapy should be started, or whether it is necessary to focus on palliative medicine methods in order to reduce the intensity of pain experienced by the patient." Hence A. Shtukov is convinced that medical workers are required to have special knowledge concerning the diagnosis and treatment of senile ailments.

In order to bring educational programs in the field of geriatrics to some common denominator, A. Shtukh and his colleagues have been collecting relevant data for a long time by interviewing specialists from 29 European countries. The goal was to make a list of at least ten items on which all the interviewed doctors would have a common opinion. Based on this list, it was supposed to develop some minimum qualification requirements for those who would then want to engage in geriatrics professionally.

The results of this work in the form of a scientific report were published in May 2014. The conclusion contained in the report was generally unambiguous: "Given the sometimes very serious differences in the quality of specialized education in the field of geriatrics at medical faculties, significant efforts will need to be made in order to implement in practice the (above) requirements (for the professional qualifications of geriatric graduates)."

Narrow specialists versus broad onesGeriatricians – doctors specializing in the problems of the elderly population – work in a variety of fields, from patient care in clinics and at home to long-term care and euthanasia under medical supervision.

In addition, they are often involved in work in structures with supervisory functions, as well as in the field of medical education.

Jurg Schlup, chairman of the "Swiss Association of Medical Workers and Workers" ("Verbindung der Schweizer Arztinnen und Arzte" – "FMH"), says that all this is ultimately good and right, but it is also necessary to ensure the fulfillment of certain structural conditions. For example, the geriatric department of a large hospital or clinic should, in theory, be in the hands of a manager who has received specialized education in the field of senile diseases.

It is also desirable to have a corresponding department in each medical school, and just here, according to T. Munzer, everything is still far from all right in Switzerland, not all medical higher educational institutions have such departments. "In terms of the organization of the educational process, we are still lagging behind," he emphasizes. Another important feature is that in Switzerland, elderly patients are taken care of not only and not even so much by geriatricians themselves. "Most of the medical services provided to elderly patients are carried out in Switzerland by home doctors, specialists from various clinics, and other doctors," says A. Shtuk.

"Therefore, all students, regardless of their chosen specialization, must take separate educational special courses in the field of geriatrics. These special courses should become an integral element of the general system of medical education, regardless of whether we are talking about pre- or postgraduate education," he is convinced.

Lack of doctors in SwitzerlandThe shortage of qualified geriatric doctors in Switzerland is superimposed on the overall shortage of physicians in the country.

At least one third of the doctors working in the Confederation were educated abroad, primarily in Germany. Jurg Schlup points out that if nothing changes, then in ten years this indicator will be at the level of 50%.

"The Swiss healthcare system is functioning well only thanks to doctors from abroad, but Germany has been making quite serious efforts in recent years to stop the outflow of medical personnel abroad and return those who have already left. And without such personnel, we have no chance of development," Yu points out. Schlup.

Another consequence of this situation is that already in Switzerland, a fierce struggle for students has broken out between different directions in medicine. "If there are, relatively speaking, departments of surgery, internal medicine and dermatology in the clinic, then competition for new student interns almost inevitably arises between them. And this means that there are fewer candidates for geriatrics," Yu points out. Schlup.

Who goes to geriatrics?"We are desperately looking for young doctors who have a desire to study and work in geriatrics," says T. Munzer.

However, today medical students prefer such promising areas as sports medicine, neurosurgery, eye diseases, or some other similar specializations, but not geriatrics. To be honest, almost no one wants to work with old people. However, I expect that many will change their minds and decide to link their careers with this particular area of medicine."

Gianna Negri, a young assistant physician from the geriatrics department of the Bern clinic "Ziegler-Spital", says that she has not yet decided for herself whether she will continue to specialize in this field, but she "really likes working with elderly patients. Many young doctors consider geriatrics boring and unattractive, but I completely disagree with this assessment. The days when we have to "work our best" and give our all are quite common here." "I believe that geriatrics is one of the most interesting medical specialties," A. Shtukh, who made his career choice back in the 1980s, is convinced.

T. Munzer is also satisfied with his specialization. "Against the background of cardiovascular surgery or neurosurgery, geriatrics may not look very attractive," says T. Munzer. He admits that the earning opportunities here are not so tempting. "We sometimes deal with very banal diseases, such as senile dementia, osteoporosis, fractures and so on. And yet, working with elderly patients can be no less interesting and exciting. After all, each patient is a special world, each case is deeply individual. And if you look at the figures, for example, showing an increase in the average life expectancy of people in Switzerland, it becomes obvious that we have a field of activity with a great future," concludes T. Munzer.

• Geriatrics is a private branch of gerontology dealing with the study, prevention and treatment of diseases of senile age.
• The scientific foundations of geriatrics as a separate discipline were laid in the UK in the late 18th and early 19th century.
• In 2012, geriatricians made up the largest group of doctors (1,252 out of 12,221 people) within the framework of the famous British medical professional association "Royal College of Physicians". In Switzerland, however, geriatrics is a relatively young science.
• The most authoritative Swiss organization dealing with age–related diseases is the "Swiss Gerontological Society" ("Schweizerische Gesellschaft fur Gerontologie" - "SGG"). The members of this structure are 1,400 people, but only 300 people have specialized education at best.
• In 2003, a separate "Swiss Specialized Society of Geriatrics" ("Schweizerische Fachgesellschaft fur Geriatrie" – "SFGG") was founded.
• In Switzerland, since 2000, there has been a separate training module in the field of geriatrics developed under the auspices of the "Swiss Association of Medical Workers and Workers" and in cooperation with the "Swiss Institute for Advanced Training of Doctors" ("Schweizerisches Institut fur Arztliche Weiter- und Fortbildung"), which is an element of the educational direction "General or Internal Medicine".

Portal "Eternal youth" http://vechnayamolodost.ru19.08.2014