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More Doctors for Older Americans?

What a geriatrician does best

Geriatricians receive at least one extra year of training in aging-related health issues. They learn to manage chronic conditions such as heart disease and arthritis, to coordinate care and prescriptions from specialists, and to focus on signs of everything from dementia and depression to faltering balance and incontinence. They counsel their patients on how to remain as healthy and independent as possible, and help them weigh the risks and benefits of surgery.

“Every elective operation, every new prescription, is of potential great benefit but also has potential adverse effects,” says Stephanie Studenski, a professor of geriatric medicine at the University of Pittsburgh. “A geriatrician is a knowledgeable advocate who helps you find your way across a complicated part of life when there are meaningful risks.”

Special knowledge helps identify problems

Yet doctors such as Dale, who is chairman of the geriatrics department at the University of Chicago Medical Center, worry that as the U.S. health care system pushes more high-tech care and ever more expensive and aggressive surgeries, it misses the big picture in the process. He recalls meeting a patient with worsening dementia whose ill-advised surgery for low-grade prostate cancer left him incontinent. This side effect created a need for more surgery, which only caused further disruptive complications.

“His dementia should have been recognized from the beginning, and they never should have started this sequence of expensive, unnecessary care, which lowered his quality of life,” Dale contends. “That’s something any reasonably trained geriatrician would have noticed.”

Medical conductors keep patients on track

Unlike some specialists, geriatricians take an interdisciplinary approach to medicine, working with teams of nurses, psychiatrists, surgeons, social workers and therapists. Geriatricians tend to be “more low-tech,” says Butler. They refer to themselves as quarterbacks or conductors, as they juggle conversations with various specialists and prescriptions from various other doctors, maintaining a focus on quality of life.

Without a geriatrician, a patient can get sent to a slew of specialists, each with a myopic interest in treating his or her area (the brain, the heart). That can lead to expensive, invasive treatments that drive up health care costs and, ironically, may undermine the overall health of the patient. A geriatrician can improve quality of life and save money by preventing falls, spotting early dementia and coordinating medications and care, notes Cheryl Phillips, M.D., president of the American Geriatrics Society.

Finding a geriatrician

In the absence of a referral, the best place to find a geriatrician is through the American Geriatrics Society. Its Foundation for Health in Aging includes a physician referral service and many links and consumer tools.

But the fact is, “we’ll never have enough geriatricians,” says David Reuben, chief of geriatric medicine at UCLA. The alternative for many patients will be to find family physicians or internists with some geriatric training and simply an interest in older patients.

Real rewards

Geriatricians say that interest can be profoundly rewarding.

“The corny part is that I was just the happiest after I had an interaction with an older patient,” says Studenski, who was a doctor of internal medicine before going on to specialize in rheumatology and then geriatrics. “Many, many people of advanced age have a wonderful perspective on life. They’re very wise, they’re often very funny. I get a lot from my patients.”

Karen Springen is a former Newsweek correspondent who lives in Chicago.

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