Letter: NHS under strain

Sir: I agree wholeheartedly with Simon Ellis (letter, 29 December) that ageism is prevalent within the NHS and that access to tests and treatment should be on the grounds of demonstrable benefit and not an arbitrary age cut-off. However, his assertion that geriatrics is a "means for rationing care to the elderly" is an inversion of the truth.

In reality, frail older patients, with multiple medical problems and their need for complex discharge planning and rehabilitation, require advocacy and expertise which is provided by geriatricians. These needs have historically been neglected by single "organ specialities", which tend to promote the study of rare conditions in younger adults and neglect the commonplace needs of the old.

This medical ageism is mirrored in nursing, where staff are drawn to high-tech specialities, and in the media, where often futile, costly cases involving children are dramatised, whilst rare mention is made of disability, degenerative disease or preventative medicine.

Geriatrics aims to respect older patients' autonomy in getting them back to their own homes and ensuring that genuine medical problems are not written off as "old age". Our received national, media and medical values do not.

Dr DAVID OLIVER

Consultant physician

Sevenoaks, Kent