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Geriatrics and the art of solving the puzzle

29 December 2023

Princess Alexandra Hospital’s long-serving pioneer in the specialty of Geriatrics, Associate Professor Paul Varghese says it is the detective work required to solve a geriatric case that has given him 40 years of clinical satisfaction. 

This too has helped to build PA’s Geriatric Service into a thriving hub that provides countless complex puzzles to inspire the current – and the next – generation of geriatricians.

Far from veteran status, the fresh-faced Director of Geriatric Medicine at PAH for the past 25 years is still delighted with his chosen specialty where the complex problems of aging, co-morbidities and polypharmacy are deconstructed and reassembled with small changes that can affect big improvements for individual patients. 

“Improving someone’s quality of life makes Geriatrics a very pleasing area to work because you see positive outcomes. You might admit someone who is bed-bound and confused and solve something in the puzzle to see them walking back out of hospital to go back home,” Dr Varghese said.

“Most people as they age will acquire a number of diseases. Modern medicine results in them seeing one specialist for each of their problems, each with a set of medications and none of the specialists end up talking to each other.  

As a geriatrician, you deal with all those problems yourself: you manage and triage all of their various competing needs and work out what's the best medication regime for them that doesn't cause them to become confused or have a fall,” he said. 

“Many GPs will send patients to us because they’ve got six different specialists and they want somebody to manage the traffic and try and simplify their drugs. Overall, starting off with a complex problem and simplifying it can be really fun to do. Plus, the patients are nice.”

In addition to the inpatient and outpatient unit, PAH has a large telehealth outreach to several small rural hospitals in the southwest of the state as well as to Redland Hospital.  Dr Varghese played a pivotal role in securing the funding to launch the tele geriatrics service which is vital for smaller or remote communities and prevents those frail patients from travelling in to a major centre. 

“This is one of the services I’m most happy to have started and developed,” Dr Varghese said. “That and the teamwork model with have with our Allied Health and nursing teams in the specialty.”

Changes over the past 40 years in clinical care are numerous, including changes in technology but the dynamic of patient care in hospitals has also changed.  When Dr Varghese was in training, hospital occupancy was between 80 and 85 per cent which is a far cry from the capacity or over census reality of sub-acute care in the modern era.  

He said patients with dementia have dramatically increased within the geriatric cohort adding pressure to bed numbers, community infrastructure and the emergence of the geriatrics in the home service over recent years which is keeping patients comfortable at home for as long as possible but is admittedly difficult to do across the breadth of Metro South Health’s catchment. 

“It is very time-consuming for staff with hours spent travelling between clients compared to the dense populations in Melbourne or London,” Dr Varghese said. “But we have successfully established Geriatric Evaluation and Management in the Home (GEMITH) as a means of managing the demand.”

But one thing that hasn’t changed is Dr Varghese's penchant for wearing bow ties which he has worn since he was a medical student 45 years ago when formality was an expectation but the issue of ties getting in the way during a suturing session in ‘Casualty’ was a reality. That’s 45 years of bow ties and he claims to have about 60-70 in his current collection, and hundreds of them along his career.

“I still like to wear a tie and I’m old fashioned enough.  They are actually very difficult to put on as you have to create a virtual loop which doesn’t really exist until you’ve made it.” 

More evidence of the detective in action and another puzzle solved every day. Congratulations on your 40 years of service, Dr Varghese.

Last updated 19 January 2024
Last reviewed 29 December 2023

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