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Consultant geriatrician Dr Jennifer Burns finds that there’s “a lot of joy and laughter” in looking after older people, even when that joy sometimes combines with sadness that a long life is coming to an end.
“Every patient is an individual. You’re never bored. And it’s also a really positive experience working with a team of like-minded people,” says Dr Burns.
For 25 years, she has enjoyed working as a consultant geriatrician at Glasgow Royal Infirmary, and hopes her passion for the specialty will be reflected in her new role as president of the British Geriatrics Society (BGS), whose goal is to improve healthcare for older people.
Learning about a patient’s past and present life
Dr Burns’ love of geriatrics started during her specialty training. “I chose geriatric medicine because I really enjoy holistic medicine, where you treat the whole patient, learn about a patient’s past and present life, and try to improve their health going forward in a positive fashion.
“It’s a very rewarding specialty because you’re taking an overview of the patient, working with them to explore what their goals are, and trying to improve their quality of life,” she says.
As well as her clinical role, Dr Burns also has a role as appraisal lead within Greater Glasgow and Clyde Health Board, and values the impact of appraisal on supporting professional development. She has a special interest in movement disorders, and has developed a specialist movement disorder service for patients with Parkinson’s disease.
Throughout her career, she has been “very involved in the training and education of future geriatricians”. She has a keen interest in undergraduate and postgraduate education and served as the lead training programme director in the west of Scotland. She has also helped to develop the curriculum for geriatricians interviewing for future specialist registrar roles.
“One of the things I enjoy the most is trying to actively recruit the next generation of doctors that will specialise and help them in the training process to become consultants,” she says.
“If you get healthcare for older people right everyone benefits. Acute hospitals work better, people offer the correct type of care, and the outcomes are better.”
Dr Burns has continued to be active in teaching medical students, from Glasgow University in particular, “on the wards, doing lectures, and trying to support them as they go through their examination process”.
Teaching is one of the “additional positives about doing a job you enjoy”, she says. “You try and pass on your enthusiasm to others, and hopefully that has the ripple effect of improving older people’s health care. Even if the people training don’t all follow in your footsteps, hopefully you are passing on that positive message about the importance of looking after older people well,” she says.
Now she is adding to her experience as president of the British Geriatrics Society (BGS). A member since she was a registrar, she says at various points in a geriatrician’s career, “you benefit from that membership, you attend educational meetings, and you then become more involved in some of the educational and policy work”.
Dr Burns has carried out different roles for the BGS, based mainly in Scotland. For two years she was chair of the BGS Scotland council from 2014-2016, at which point she became more involved in the UK-wide society.
In 2018, when the opportunity came up to put her name forward for the presidency role, Dr Burns says she was “at a point in my career where I thought I maybe had something to offer. I just put my name in the ring, thinking ‘what will be, will be’.”
Championing interests of BGS members
Now, after two years as president elect, she is looking forward to her two-year term as president, which began in November 2020, and to championing the interests of a membership that includes not only geriatricians, but also general practitioners, care home nurses, and allied health professionals.
“It’s definitely an honour to have been elected as president. I feel that I’ve got a responsibility to do as well as I possibly can to keep up the high standards that the society offers its members, and to reflect and comment on the issues that are relevant to our patient group appropriately,” she says.
The aims of the BGS, she says, “really do chime with the things that I think are important”.
“Our strapline ‘improving healthcare for older people’ is key to the BGS. It’s more than just a membership society to support the education of doctors and allied health professionals. We want to try and have that broader influence in improving older people’s health care.”
“While our skillset is being used in lots of different ways in the NHS, this means we can end up being spread very thin.”
She explains one of the ways the society hopes to achieve this is to try and enhance clinical quality by “improving the knowledge base and practice, and providing guidance on what to do in certain situations”. The BGS has been involved in producing resources for the Covid pandemic for older people, guidance on how best to manage patients with frailty, and is working on other resources for not just members of the society, but others looking after older people.
Dr Burns is keen for the BGS to continue to look at the wider education of medical students and doctors. “If you get healthcare for older people right everyone benefits. Acute hospitals work better, people offer the correct type of care, and the outcomes are better.”
But she says it’s important that it’s “not just geriatricians trying to do it all, because we clearly are a relatively small number of doctors. We have to be able to influence primary care and other specialists in secondary care”.
Dr Burns says “a big stream of activity” for the BGS is trying to influence policy across the UK. “We’ve got four nations now with fairly devolved healthcare. As a Scot, I think we have to share best practice, firstly across those four nations through BGS and try and influence the different polices in the four nations,” she says.
The pandemic and its impact will inevitably shape Dr Burns’ plans for the society during the next two years. “As I was watching the pandemic play out when I was president elect, I could see that not only was the virus disproportionately affecting older people and residents of care homes, but it was also having an impact on the workforce, such as burnout.”
Workforce wellbeing for geriatricians
Workforce wellbeing is also on her agenda as president. “We need to support the workforce. We’ve undertaken a survey of how they found ‘first wave’ and are looking at what we can do to support their wellbeing,” she says.
The BGS offers a network of support for its members, partly through conferences and special interest groups. €œWhen the profession has had an unprecedented year of pressures, the ability to have peer support and learn from one another is probably even more important.
“So I’m glad we’ve been able to maintain virtual conferencing this year, but I am keen that we get back to some more face to face meetings that’s important as well,” she says.
Addressing recruitment and training issues will be one of her priorities during Dr Burns’ term as president. “I’m keen that we continue to recruit and train as many individuals as possible to move the specialty forward,” she says.
This can be achieved by role modelling – exposing medical and nursing students to high quality experiences of working in geriatric medicine and associated areas, and ensuring that the training programmes meet their needs, she says.
Demand for flexible training
During the course of her career she has noticed an increasing demand for flexible training in the specialty, as more doctors look for a work-life balance. “We need to be seen as a specialty that offers flexibility, while still valuing and training people to the same standards,” she says.
Dr Burns will be pressing the Government about the need to continue to recruit more doctors, that there are enough training posts for them, and that they are able to train in geriatric medicine as part of their early years training “so that they get exposure to the best practice”.
The BGS wants to “work on our policy voice on improving healthcare for people living in care homes”, she says. Aware that the care home population were very vulnerable to the impact of Covid-19 and that they “weren’t front and centre of the initial thinking about how the NHS responded to it”, she says BGS was one of the first groups to produce guidance for care homes on managing the virus.
She suggests that “potentially a positive to come out of something very difficult is we now have more proactive ways of providing good healthcare for residents”. For example, she says the BGS would like to develop the “hospital at home’ service, which allows residents to have access to treatment they would normally only receive in a hospital setting.
One of the challenges geriatricians face, she says, is that “while our skillset is being used in lots of different ways in the NHS”, such as developing the ‘hospital at home’ model, or working with surgeons to improve outcomes of acute surgical care, “this means we can end up being spread very thin”.
“We cannot look after absolutely everyone that might benefit from our care, so we need to have the ability to work effectively in teams to train non medical specialists, and influence the skills of doctors that work in other areas,” she says.
Retention within the specialty she says “is under researched”, adding that the BGS “needs to think about how we can capture information about this issue”.
“One of the big questions we might ask in our next workforce survey is: “Are you thinking of retiring early and what are your intentions for retirement?”, she says.
Doctors thinking of entering the specialty can expect it to be “an incredibly rewarding area to work in”, she says. “The clinical role allows you a bit of continuity with patients.
“While you will see people with complex health problems, often at a point of crisis, with the input of the multidisciplinary team you can help to improve their health and then you can work towards planning for them to go home. Seeing that recovery, and working with the patients and their families towards what everyone wants, which is for them to get well and leave hospital, is very satisfying.”
Reflecting on what it means to provide care to a patient group that’s “rich in experience”, she recalls the last patient on her ward round that day, a 95 year-old lady who was going home. “She said to me: ‘I feel young’.” Just one of many reminders, she says, of “the joy of looking after older people well”.
The British Geriatrics Society is the membership association for professionals specialising in the healthcare of older people across the UK.