Why is Geriatrics unpopular?

Earlier I talked about the need for a different paradigm in geriatrics. I think one of the reasons Geriatrics is unpopular is because doctors try to apply that hypotheticodeductive paradigm to geriatrics with frustrating ineffectiveness.

The hypotheticodeductive model is also appealing, simple and easily explainable to the patient, so even doctors who do understand that it isn't relevant to geriatrics might prefer another field where it is of more utility.

Finally, the Geriatrics model applies most to those major problems of geriatrics, but certainly not all, and to be an effective geriatrician you need to be able to know when to apply it and when not, for example, in incontinence it is clearly very relevant, in acute chest pain the hypotheticodeductive model is superior.

That's clearly not all the reason.

Those not in or close to the profession may not believe this, but almost all doctors want to make people better. The best way to do that is to cure them of their disease so it never comes back, explaining the appeal of surgery as a career. Most problems in internal medicine (see a future post for the difference between surgery and internal medicine) are not curable, especially so in geriatrics, and even if they were its certainly true that older people are unable to enjoy the cures for as long.

The antidote to this in my opinion comes from palliative care - goal directed medicine. In their are usually implicit assumptions about the goal - for example in surgery the goal is the cure of the disease via surgery. In pathology on the other hand the goal is diagnosis of the disease. In neurology frequently the diagnosis is often pursued to a point where I personally feel it has become irrelevant to the treatment of the patient and has become a goal in itself. In palliative care it the comfort of the patient and family.
In geriatrics the goal could be any one of these, so it is very important to START with identifying with the patient and the family what is the goal of the interaction.

More on this topic soon.