Profiles in Geriatrics

Tell us a patient care story where your geriatrics training was especially useful.

A few months ago, I had recently graduated from the Harvard Multi-Campus Geriatrics Fellowship, and I was flying off for vacation when drama ensued. Over the speaker came the question: “Is there a doctor or nurse onboard?”

I was the only physician on board, and I answered the call along with a cardiac nurse. We discovered our patient was a middle-aged passenger in the throes of crushing chest pain. We managed to stabilize the passenger and recommended that the plane divert for landing. Thankfully, the passenger made it to the hospital alive.

I’d done plenty of emergency simulations during my internal medicine residency at Brigham and Women’s Hospital, but this situation demonstrated how my geriatrics training was particularly helpful. As a geriatrics fellow, we learned how to handle cases where there’s a lot of ambiguity. Geriatrics teaches you how to embrace whatever happens and how to provide compassionate care for an older person, the family—and yourself.

That’s an incredible story. What happened next?

I knew that my experience would be useful to other healthcare providers, so I tweeted out anonymized details of the in-air rescue, using the “tweetorial” format because it allowed me to tell the story in a way that suited the case. I had originally started using Twitter to keep up with research literature, because it helped me read more articles and engage in discussions about them.

But then my tweets went viral! I thought my 20 or so followers would enjoy reading about my experience—but I ended up getting over 18,000 “likes” and just over two million total views. The response was overwhelming. I heard from lots of folks who’d been in similar situations—even a former surgeon general left a comment.

It seems like this is a lesson in the power of social media as a tool for clinicians.

Social media has a positive role to play in our medical careers. It gives professionals who aren’t researchers a voice and a platform to share their experiences. Typically, researchers have always had a place to share their work, but I think using social media helps give us all a forum—particularly for stories that may not fit neatly in a journal.

How has your openness about your experiences on social media translated into your professional life?

In some respects, that same openness is what makes a community like the AGS so important. I became an AGS member right after I decided to apply for a geriatrics fellowship in my last year of residency. I hadn’t met a lot of people who were interested in geriatrics, so this was a great way to meet like-minded folks. Once I joined, I found lots of online groups to engage with and share ideas with.

For instance, at #AGS19 in Portland, I presented some of my research, and attended the Healthy Aging Special Interest Group session. I had the wonderful opportunity to hear Louise Aronson, MD speak about using personal narratives and how stories can impact our practice.

Looking ahead to the future, I can see how the trajectory of geriatrics is trending toward the positive. It used to be that we focused on the ‘negative’ syndromes, like falling, incontinence, and dementia. Now we’re also focused on healthy aging, and I look forward to helping my patients realize the positive aspects of the aging process.

It seems most geriatrics professionals have a personal reason for the choices they’ve made in a career path. What brought you to the field?

My interest in geriatrics was inspired by my especially loving relationship with my maternal grandmother. I’d decided to become a doctor, and as I progressed through residency, my grandmother became ill and frail. I didn’t live close to her, yet I could see how fragmented her care became. It was frustrating that I didn’t have the tools to help her.

That sparked my realization that while I had great skill in being able to care for children and middle-aged adults, I didn’t feel so confident caring for older people. I felt that specializing in geriatrics would give me the tools I needed. I discussed this with Dr. Ken Brummel-Smith, the chair of the department of geriatrics at my medical school, Florida State University. He encouraged me to pursue and apply for a geriatrics fellowship position.

How has AGS membership helped you as you’ve navigated your career?

I joined AGS as soon as I became a geriatrics fellow and I can say honestly that membership has enhanced every single aspect of my professional life. Just for starters, AGS gives me access to countless resources and to a community of people, all dedicated to making the lives of older adults better. And that makes me a better geriatrician.

For example, in addition to my “day job,” I’m Chair of the AGS Teachers Section and in that role, I communicate through the MyAGSOnline Teachers Section Community to engage other AGS educators. It’s a fantastic tool for so many needs—it’s a great way to find reviewers for your abstract, for example. And if you have a query, you can put it out to this large group of amazing people and are sure to get scores of helpful answers in return.

What do you enjoy most about teaching?

I think it’s a privilege to teach others how to care for older adults. It’s something that health care professionals think they know how to do, but when you show them the nuances, you see all these lightbulbs go off in their heads.

In my teaching work, I focus on making geriatrics personal. One way I accomplish this is by giving each student an index card. I ask them to write down the name of an older adult who has meant the most to them—then we share their stories. I tell them that when they get distracted, they can bring their focus back to that person. “They’re the reason you’re sitting here,” I remind them.

What’s one way you’ve tried to “reframe” aging to your students—a way of speaking about and interacting with aging that breaks away from popular stereotypes or expectations?

Another aspect of practicing geriatric medicine is understanding what healthy aging can look like. I realize that very often, students only see older adults when they’re sick and in the hospital. So, they’re mostly seeing frail, sick older people—not those who are aging well.

Working with a retirement community in our hospital’s neighborhood, we arranged to bring med students there to have dinner with the residents every few weeks. It turned out to be a tremendous success—and it’s hard to tell who has the most fun, the students or the residents! Seeing healthy older adults gives the students a whole new perspective on their work in geriatrics—it shows the range of experiences we have as we age and illustrates the need for truly person-centered care. That’s the greatest teaching point of all!

Why did you choose geriatrics?

I grew up around older adults, and that stimulated my desire to learn more about their medical needs. As I studied medicine, my interest became a passion to specialize in geriatrics. During my training and after I became a geriatrician, I realized how much work there is to be done in our field. I also realized that we have plenty of opportunities to improve the care we provide to older adults.

You split your time between patients and students as a clinician-educator. What’s that like?

Touching the lives of my patients and their families and making a positive difference for them is extremely rewarding. In my practice, being part of interdisciplinary teams and working with dedicated colleagues inspires me every single day. I also love the teaching opportunities my job offers—I enjoy working with different learners and I feel like I’m a teacher in doctor’s clothing.

What’s your AGS story?

I’ve been an AGS member since my fellowship training in 2010. It seemed like a natural move to join—the AGS is the professional home for geriatrics healthcare professionals. Plus, I got a little push to join from my mentor and the faculty of my fellowship program. The opportunities the AGS offers during our Annual Scientific Meetings to share work and network with other fellows was also enticing.

I happen to have a special interest in transitions of care. The AGS helps me connect and work with others who share that passion in the Transitions of Care Special Interest Group. Its members are subject-matter experts who meet to share their knowledge, ideas, and experience.

My AGS membership affords me plenty of opportunities for collaboration, networking, and career development. I’ve made friends outside my own institution and I’ve worked on projects with colleagues I’ve met through the AGS. What’s more, I’ve been able to participate in activities that have contributed to my professional growth, including attending career development courses, finding mentors outside my home institution, and participating in review panels.

What do you like most about AGS Annual Meetings?

Some meetings have been particularly memorable. In 2012, my abstract was selected for an oral presentation. As it happened, the meeting was in Seattle, where my wife’s best friend and some of our family live—so my family got to watch my presentation; that was pretty special.

I’ve only missed one AGS Annual Scientific Meeting in the eight years I’ve been an AGS member. To me, the meetings are like family reunions where I reconnect with friends and colleagues. I get rejuvenated and inspired from hearing about the growing recognition for our work and its relevance in health care. As we engage with each other and get to share what we’re doing, I always learn something new. And I return to my institution with new ideas to share and implement.

What drew you to geriatrics as your chosen career path?

A gut feeling. I took a leap of faith when I decided to go for a geriatrics fellowship after my residency at LSU University Medical Center—Lafayatte (now part of Lafayette General Medical Center) because I was the first one in my program to enter geriatrics.

I guess you could say my choice was unexpected, since I’d done a nephrology fellowship in West Africa before moving to the United States. So, when I arrived at Tulane University to begin my geriatrics fellowship, I didn’t know what to expect. I did know I’d return to my community after completing my geriatrics fellowship so that I could give back—there are so few trained geriatricians in Louisiana. I knew I’d enjoy working with older adults and making a positive difference in their lives.

What does your work environment look like, and how have your interactions with other health professionals driven geriatric care forward?

I joined the Veterans Health Administration (VHA) in 2004 because I saw the need to care for the large population of older adults who’d served our country. I’ve been active with the VHA Geriatric Patient Aligned Care Team (or GeriPACT) and in my community by offering geriatrics lectures to other healthcare providers. Though there are still too few geriatricians, my goal is to help train every healthcare provider around me in geriatrics expertise.

To that end, I’ve seen how my AGS membership has benefitted me personally and professionally. Today, I enjoy providing high-quality and person-centered care to our nation’s veterans—and I’m happy to belong to a community of colleagues who are living proof of that same passion every day.

You are a regular attendee of AGS Annual Meetings. Can you share a favorite meeting story?

When I attended my first AGS Annual Scientific Meeting in 2002 as a fellow-in-training, I was impressed by the friendly, supportive atmosphere, though I knew no one there. The AGS members were wonderful, and I knew I needed to belong to this organization.

During that first meeting, I was also struck by the willingness of AGS members to support and mentor junior fellows like me. For example, after I attended a lecture by Laura Mosqueda, MD, AGSF, on elder abuse, I introduced myself to her and she immediately volunteered to be my mentor and cheerleader. She believed in me and inspired me to complete my fellowship program. At that meeting I also met Kenneth Shay, DDS, MS, AGSF, and we talked about the prospect of working at the VA. I’ll always be grateful for that, especially since it led me to the career path I am on today.

Why do you continue to attend the AGS Annual Meeting—what are the benefits of returning each year?

I still attend the AGS Annual Meeting each year—even though it often coincides with my wedding anniversary! I’ve benefited from the many networking opportunities and I’ve made great friends from all over the country. I enjoy the meeting’s fun, diverse atmosphere, which fosters my professional growth. For example, the support I receive from AGS meetings enabled me to reach a personal goal of becoming an AGS Fellow in 2017.

The AGS is a place where everyone is valued and all opinions are respected. As a junior member, I suggested to then-AGS-President Barbara Resnick, PhD, CRNP, FAAN, AGSF, that new AGS Fellows should be recognized on stage during the Members Business Meeting. I was thrilled when that change was enacted.

How has being part of an interprofessional community helped you in your career and professional life?

As a clerkship director, I was looking to make changes for fourth year medical students and was feeling alone, so I turned to the greater geriatrics community on MyAGSOnline (AGS’s discussion forum). By posting just one question to ask for advice, I had chairs and clerkship directors from all over the country emailing me and sharing their curriculum, which was extremely helpful. While going for a promotion to Associate Professor with tenure at my university, it was very helpful to find external reviewers. They gave invaluable advice for the promotion. I have to say thank you to my AGS community.

As a young professional, what types of AGS resources are most important to you?

Clinical, educational, and research resources, as well as updates on health policies and new changes proposed.

How have your personal experiences and stories helped shape the way you practice?

I had complications while pursuing my geriatrics fellowship after an emergency surgery. It took a whole year to be fully diagnosed after many physician and specialist visits, and finally was resolved completely when a surgeon patiently listened to my full story. It taught me important lessons to listen to my patients and to believe them, as it can change their quality of life and get them the help they need. It has also helped me make healthier lifestyle choices, which I always discuss and encourage my patients to follow.

What inspires you?

Everyone at AGS inspires me, and that is why I keep coming to the meeting every year. It is an honor to meet hard working, motivated folks in geriatrics who every day go above and beyond what is expected of them to make someone else’s life better.

Do you have a favorite story about a patient, family caregiver, mentor or other person who has touched you personally and/or professionally?

Mrs. D was my first patient in my fellowship at a geriatric clinic. We started rather awkwardly—I introduced myself and told her I was new. She smiled, reassuring me we’d get along fine. At the end of the session she reminded me to send her the lab work early, and complimented me on a thorough visit. We had many more sessions over the next decade.

We discussed more than her health – her life, work and her children. When my twins were born, she brought them hand-knitted sweaters and socks. She never left a visit without seeing a picture of my children or asking how they’re doing. I realized there is never a one-way exchange in a relationship between physicians and patients.

After Mrs. D’s death, I called her daughter and she told me that many times in her last days, she remembered me and proudly discussed with the hospital staff that she had seen all the progress of my career. I feel truly blessed that she was my patient and it was an honor to know her.

When did you know you wanted to be a geriatrics healthcare professional?

My “Aha!” moment came during my internship at Montefiore Medical Center in New York. Before entering medical school I had worked in the breast oncology clinic at Memorial Sloan Kettering Cancer Center. I had entered medical school and internship with plans to become an oncologist. I was fortunate to have had a wonderful mentor, and at the end of my intern year we had a chat.

She told me she saw things in me that I didn’t see in myself—that I was drawn to palliative care (then a relatively new field), for example, and we started talking about geriatrics. I spent time in the geriatrics department, and I realized her encouragement was spot-on.

What’s your favorite thing about working in this field?

Geriatrics satisfies me in so many ways. I love the older adults I care for, in large part because I love hearing their stories. It’s rewarding to help older adults regain function and the ability to interact with people. I’m doubly fortunate in that my work at the Yale University School of Medicine in Connecticut also entails helping train future geriatrics healthcare professionals. My work teaching is every bit as gratifying as my clinical work, though for equally special yet unique reasons. When I work with trainees, I get to see things through their eyes; their perspectives are enlightening. Teaching really is a two-way street!

How has being part of an interprofessional community helped you in your career and professional life?

A terrific aspect of geriatrics is the community it represents. We all seem to be kindred spirits and a success for one is a success for all. I’m definitely living proof of that, because recently, I was extremely honored to receive the AGS’s Outstanding Mid-Career Clinician Educator of the Year Award. It’s a testament to the AGS that our members are so big-hearted: I was thrilled to receive so many congratulatory notes and accolades from my colleagues. Receiving the award was not only a wonderful professional tribute for me but also underscored the importance of the work we do together.

I suppose that’s part of why I’ve been an AGS member since 1999. Events like the AGS Annual Scientific Meetings have helped me celebrate my peers’ successes while also affording me the opportunity to see what they and other leaders are doing. Membership in the AGS is one key way I’ve learned about innovation in our field so I can stay current with research.

Another key aspect of my membership is that it exposes me to the advocacy AGS leads on our behalf. With health policy in flux these days, we all need to be advocates for our field, and—thanks to AGS—I’m inspired to add that to my own list of important things to do.