Geriatrician reflects on his specialty’s “big picture” approach
The complexity of seniors’ care and the regular need for a tailored, person-centered approach is what drew Frank Molnar, MD, FRCPC, to the field of Geriatric Medicine.
“I chose this specialty quite early because it’s really a combination or hybrid of multiple specialties,” says the geriatrician at the Ottawa Hospital and associate professor of medicine at the University of Ottawa. Now in his 27th year of practice, Dr. Molnar says he likes the “big picture” approach of geriatrics — that includes looking at psychological issues and the social determinants of health, in addition to the medical issues.
“We ask, ‘How do I help the whole person and how do I help the family?’ If you like that level of complexity, not dealing with just one system or one organ, then this is a field for you.”
Geriatric Medicine specialists are sometimes referred to as the “pentathletes of Internal Medicine” because of their training in five areas: Internal Medicine, Psychiatry, Physical Medicine and Rehabilitation, Neurology and health program design.
The field is also guided by the GERIATRIC 5Ms: Mind, Mobility, Multi-complexity (biopsychosocial perspective), Medications and what Matters most — the latter referring to which investigations and treatments should be pursued, given a patient’s other conditions (i.e. realistic and meaningful “Goals of Care” and “Advance Care Planning”).
Dr. Molnar says awareness of seniors’ health care is growing with the aging of Canadian society, but he does not yet see the necessary investments being made.
“Our system is very much focused on cancer and cardiac conditions, but many seniors have various other issues that need a different approach to medicine that we have not really addressed.”
The population aged 65 and over is going to double in the coming years, he notes, but more attention has to be paid to the expected quadrupling of the 85-years-plus demographic. This group has multiple interacting diseases as well as psychological and social issues — patients our system was not designed to care for.
“They are filling the hospitals,” he says. “There is no way you could build enough hospitals for that population growth if we do not radically change our focus.”
Dr. Molnar says a critical part of the solution is to develop community care teams that integrate specialists, primary care and home care. In other words, we must build specialist support into home care to keep the most medically complex seniors out of hospital by treating them in the community and, when necessary, in their homes.
“If we don’t do that, we’re not going to be able to keep people out of the hospital and our hospitals are going to become even more overwhelmed. This will adversely affect access to care for Canadians of all ages”
Dr. Molnar says biases against his specialty continue today, which often reflect misunderstandings about seniors’ health care needs and the critical role of Geriatric Medicine. He also notes bias against seniors.
“Some people think that seniors are bed-blockers, jamming up the health care system,” he says. “But the truth is that we are the cause because we are not providing the care seniors need, the way they need it, when and where they need it.”