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December 23 2009

Policy for an Aging SocietyA Review of Systems

Author Affiliations

Author Affiliation: Dr Cassel is President, American Board of Internal Medicine, Philadelphia, Pennsylvania.

JAMA. 2009;302(24):2701-2702. doi:10.1001/jama.2009.1901

Medical students and residents are taught to perform a complete review of systems in a thorough patient workup. Through this process, patients may report less prominent concerns that may be meaningful to the physician's evaluation. As a complement to the new series, Care of the Aging Patient: From Evidence to Action, in this issue of JAMA, a Commentary will provide a forum for discussion of a policy review of systems for the care of older adults.

In the first article, Reuben1 brings into sharp relief the need for greater expertise and new approaches to caring for older patients as they face physical decline and advanced illness. Using the case of Mr Z, Reuben examines the patient-care encounter and the analytical and interpersonal processes that the physician must undertake. For most US physicians, both specialists and generalists, this story is likely unfamiliar, and physicians may hardly be able to imagine themselves or colleagues conducting the kind of extensive evaluation described. Patients would flock to this comprehensive yet individualized care.

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