ALT Editor-in-Chief of Age and Ageing journal, Professor Rowan Harwood, ruminates on the dualism between old age psychiatry and geriatric medicine as he reflects on recently published research evidence. '1 am a not a social worker and I'm not a psychiatrist'. I was taken aback when a frustrated colleague once announced this at a meeting (quite a long time ago). Did we not believe in the confluence of the physical, the mental and the social? For sure, geriatricians are physicians, but we are also generalists. Almost uniquely, a geriatrician's expertise is broader than that of the parent discipline, internal medicine. We need to be good at rheumatology, neurology, palliative care, a bit of gynaecology and oncology, ethics, law and sociology. That brings tensions. Who is the primary expert in heart failure or diabetes in frailty, the cardiologist, the diabetologist or the geriatrician?