Doctor Sees a Growing Need for Geriatrics in an Aging America

When Dr. Christine K. Cassel went into geriatrics, she felt like a cheerleader.

“Our conventional medical training and the systems of health care we have set up are just not suited to the care of the very ill, very frail people that have complex medical, social, economic and psychological problems,” she says.

“Geriatrics puts all that stuff on the table. It says that it is every bit as important for you to know the physiology of the kidney as it is for you to know how the Medicare system works. That it’s every bit as important for you to know what your patient’s blood cholesterol and blood count is as it is for you to know whether your patient can go to the bathroom by herself and whether this person has a family at home.

“That’s part of my goal--to expose doctors to some of these kinds of social questions.”

After working on the faculty of the Mount Sinai Medical Center in New York, the country’s first medical school to start a department of geriatrics, Cassel, 42, was recruited by the University of Chicago medical school to be chief of its internal medicine section.

Shortly after her arrival a few years ago, Cassel started the school’s Center on Aging, Health and Society, a universitywide program bringing a multidisciplinary focus to training and research about the complex issues of aging.

Cassel’s other initiative is a model ambulatory-care center for older adults. It is in the former Windermere apartment building in Chicago, which she referred to as “an elegant old building for elegant old people.”

With on-site dentistry, ophthalmology, dermatology and gynecology, as well as laboratories and X-ray facilities all in a small, convenient location, it avoids what Cassel calls “the big modern hospital complex where you have to walk 4 miles to get your blood drawn and 3 miles back in another direction to get your X-ray.”

In recognition of the interaction of medical and social problems, the center has a full-time social worker. And, as an added service, the seniors’ clinic processes all its patients’ Medicare and supplemental insurance forms upon request.

“That may seem unimportant. But when people get to that age and have a lot of medical problems and a lot of paper work to deal with, it’s amazing how important those issues become,” she says.

According to Cassel, “the problems of integrating chronic illness with family issues and the real world have just not been taught to physicians.

“What you have to do is take this stereotype of old people being boring and depressing and uninteresting, and say to the medical student or to the referring physician, ‘What a great case. This is fascinating.’ Most of the time, it’s true.”

Seeing “the whole picture as their territory,” Cassel explains, can give health professionals satisfaction. They can “learn that this is a very exciting feeling to engage with a family and to make a difference at that level.”

Cassel notes that a study done a few years ago by the Rand Corp., a think tank based in Santa Monica, predicted that by 1990, the United States would need between 6,000 and 8,000 geriatricians. She estimates that only about 800 physicians are trained in the field.

Cassel says the point of this new medical specialty is not to send every person older than 70 to a geriatrician, but to give doctors treating the growing population of American elderly the comfort of knowing that when a complex problem arises, there is a specialist who can help them.

“I don’t have any illusion about making a huge difference,” Cassel says. “But I want to make whatever difference I can.”