I recently had the opportunity to speak with two physicians who are board-certified geriatricians. Dr. Myles Sheehan and Dr. Rahmawati Sih . Both physicians are affiliated with Loyola University, Dr. Sheehan in an academic role now and Dr. Shi with a large medical group. Dr. Sih is also medical director for a nursing home and responsible for the care of those patients along with those she sees in her practice. She completed a residency in Internal Medicine, as did Dr. Sheehan. This was followed by a fellowship in Geriatric medicine.
I asked both physicians why they chose this specialty, and both answered that they found working with older adults to be very rewarding and enjoyable. They described the care they gave as more holistic, as medical social and psychological problems with seniors tend to be intertwined. Dr. Sih described and encounter with a patient who was loosing weight. As they talked she was able to bring out the fact that she did not like to cook for herself, digging deeper it became evident that the problem was more of a social problem. She did not have the social support or resources to get out purchasing food, and physical limitations kept her from cooking for her as she should. With the proper evaluation, the necessary social services were brought onto the scene.
Dr. Sheehan and I discussed whether every older person should have a geriatrician as his or her primary care provider. He felt that was neither necessary nor practical. Despite the growing aging population, the number of geriatricians is not growing and is in fact decreasing . Both physicians state that they were trained to treat the older and frailer senior adult. A fairly healthy 70-year-old could be assured of receiving adequate care from an Internal Medicine physician or family practice physician. Geriatricians can be found in larger urban centers. Because of the low monetary compensation and the image that treating geriatric patients is not rewarding or exciting this is not an attractive specialty for many physicians.
Dr. Sih and I spent some time discussing medications and pharmaceutical costs for her patients. She felt that was one of her greatest challenges when it came to providing good care. She states she would often have to prescribe a lower cost and perhaps less effective medication at the request of her patient. Her patients know what they can and cannot afford and part of the care she gives has to make allowances for her patient's social situation. Giving someone a prescription for a medication they will not fill due to cost does no good.
As for the future, both physicians agreed that prevention is the best medicine. By practicing good health habits now, baby boomers can enjoy a more enjoyable and healthy old age. Dr. Sheehan also wanted to emphasize that despite the good medicine can do there will be decline of function and eventually death. He worries that the baby boom generation will have a difficult time dealing with the decline that aging can bring.
The good news is that seniors are much better informed and educated in health care issues. Dr. Shi she often sees patients armed with information found on the web or in the news. They are more willing to discuss their problems and will question the treatment they are receiving.
Who would receive the greatest benefit from treatment and care by a geriatrician? Both physicians agreed that with the limited number of geriatrician's those with the greatest needs are:
- The frailest old with multiple medical problems.
- The older adult with multiple medical problems and limited social support.
- The older adult with those medical problems primarily associated with aging.
Additional training received during their fellowship has equipped these to deal with problems such as memory loss, dementia, pressure sores, falls, weight loss and polypharmacy (multiple prescription medication needs). They are also equipped to identify social and economic problems that may impede care. If you or an older loved one has multiple medical problems it may be worth your while to see or consult with a physician like Dr. Sih or Dr. Sheehan.