Teaching Geriatrics-Reply

In Reply.—  Dr Portnoi's letter raises many interesting issues and presents viewpoints on many diverse subjects. We agree with some of the stances offered (the need for an organized system of health care for the elderly) and question others (that the solution to the ills of British geriatrics is to be found in shifting its emphasis to the community). We make this last point despite our interest in out-of-institution care; Boston University has a home medical service that dates to the 19th century and that is an integral part of geriatric medicine. Furthermore, we applaud many of Dr Portnoi's well-known efforts in geriatrics at George Washington University.Nonetheless, the contents of his letter seem to bear little relevance to our description of a university hospital consultative service that was "designed to provide a comprehensive consultation for the geriatric patient at a short-term care university hospital" where 45% of the general