Treating Our Societal Scotoma: The Case for Investing in Geriatrics, Our Nation's Future, and Our Patients
Authors: Rosanne M. Leipzig, William J. Hall, Linda P. Fried
Journal: Annals of Internal Medicine (2012)

In the Balance1 May 2012Treating Our Societal Scotoma: The Case for Investing in Geriatrics, Our Nation's Future, and Our PatientsRosanne M. Leipzig, MD, PhD, William J. Hall, MD, and Linda P. Fried, MD, MPHRosanne M. Leipzig, MD, PhDFrom Mount Sinai School of Medicine and the Mailman School of Public Health of Columbia University, New York, and University of Rochester School of Medicine, Center for Healthy Aging, Rochester, New York.Search for more papers by this author, William J. Hall, MDFrom Mount Sinai School of Medicine and the Mailman School of Public Health of Columbia University, New York, and University of Rochester School of Medicine, Center for Healthy Aging, Rochester, New York.Search for more papers by this author, and Linda P. Fried, MD, MPHFrom Mount Sinai School of Medicine and the Mailman School of Public Health of Columbia University, New York, and University of Rochester School of Medicine, Center for Healthy Aging, Rochester, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-9-201205010-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the United States, our society has a scotoma, which prevents us from seeing the necessity of changing our health system in the face of an aging population. It also prevents us from investing in the expertise of geriatric medicine, training an adequate number of geriatricians, and ensuring that all physicians have basic competency in caring for older patients. As we attempt to reform our unsustainable health system, it would be perilous not to recognize and resolve this blind spot.Geriatricians are experts in helping patients set goals and providing goal-appropriate medical care to an aging population (1–4). Over the ...References1. Fried LP, Hall WJ. Editorial: Leading on behalf of an aging society [Editorial]. J Am Geriatr Soc. 2008;56:1791-5. [PMID: 19054197] CrossrefMedlineGoogle Scholar2. Reuben DB, Tinetti ME. Goal-oriented patient care—an alternative health outcomes paradigm. N Engl J Med. 2012;366:777-9. [PMID: 22375966] CrossrefMedlineGoogle Scholar3. Reuben DB. Medical care for the final years of life: “When you're 83, it's not going to be 20 years”. JAMA. 2009;302:2686-94. [PMID: 20040557] CrossrefMedlineGoogle Scholar4. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. 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Comparison of number of certificates awarded to number of active certificates in geriatric medicine (family medicine and internal medicine). Cincinnati, OH: American Geriatrics Soc; 2011. Accessed at www.ipittr-test.uc.edu/GWPS/files/Figure%201_3.pdf on 18 March 2012. Google Scholar18. Geriatrics Workforce Policy Studies Center. Total annual compensation for private practice physicians, 2006-2010. Cincinnati, OH: American Geriatrics Soc; 2011. Accessed at www.ipittr-test.uc.edu/GWPS/files/Table%201_7.pdf on 18 March 2012. Google Scholar19. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780-91. [PMID: 17493201] CrossrefMedlineGoogle Scholar20. Siu AL, Spragens LH, Inouye SK, Morrison RS, Leff B. The ironic business case for chronic care in the acute care setting. Health Aff (Millwood). 2009;28:113-25. [PMID: 19124861] CrossrefMedlineGoogle Scholar21. Farber J, Siu A, Bloom P. How much time do physicians spend providing care outside of office visits? Ann Intern Med. 2007;147:693-8. [PMID: 18025445] LinkGoogle Scholar22. American Board of Internal Medicine. Subspecialties/geriatric medicine policies. Philadelphia: American Board of Internal Medicine. Accessed at www.abim.org/certification/policies/combinedss/comgeri.aspx on 18 March 2012. Google Scholar23. Boult C, Counsell SR, Leipzig RM, Berenson RA. The urgency of preparing primary care physicians to care for older people with chronic illnesses. Health Aff (Millwood). 2010;29:811-8. [PMID: 20439866] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Rosanne M. Leipzig, MD, PhD; William J. Hall, MD; Linda P. Fried, MD, MPHAffiliations: From Mount Sinai School of Medicine and the Mailman School of Public Health of Columbia University, New York, and University of Rochester School of Medicine, Center for Healthy Aging, Rochester, New York.Acknowledgment: The authors thank Karen L. Sauvigné, MA, for her editorial and technical support.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0760.Corresponding Author: Rosanne M. Leipzig, MD, PhD, Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, 1468 Madison Avenue, Box 1070, New York, NY 10029.Current Author Addresses: Dr. Leipzig: Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, 1468 Madison Avenue, Box 1070, New York, NY 10029.Dr. Hall: University of Rochester School of Medicine, Center for Healthy Aging, Box 58, 1000 South Avenue, Rochester, NY 14620.Dr. Fried: Columbia University Medical Center, Mailman School of Public Health, 722 West 168th Street, Room 1408, New York, NY 10032.Author Contributions: Conception and design: R.M. Leipzig, W.J. Hall.Analysis and interpretation of the data: R.M. Leipzig, W.J. Hall.Drafting of the article: R.M. Leipzig, W.J. Hall.Critical revision of the article for important intellectual content: R.M. Leipzig, W.J. Hall.Final approval of the article: R.M. Leipzig.Administrative, technical, or logistic support: R.M. Leipzig. 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