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Experience and challenge shape doctors for tomorrow's seniors

This article first appeared in the St. Louis Beacon, Feb. 13, 2009 - One doctor remembered growing up with her grandmother. Another watched his wife's family deal with a loved one's Alzheimer's Disease. Another simply wanted to get away from snow. Whatever the reason, a love of challenge and caring for seniors drives the doctors teaching and learning in the Geriatric Medical Program at St. Louis University Medical School.

After growing up with her live-in grandmother in New Jersey, Lenise Cummings-Vaughn loved being around them as a doctor, gushing about them to interns.

"I'd tell my interns that 'I want to put this person in my pocket and take them home with me,'" Cummings-Vaughn, 36, said. She still gushes and is among the eight doctors training in SLU's program. These doctors will specialize in a field few go into, despite a growing need nationally.

Geriatricians are doctors who specialize in treating the elderly. According to the American Geriatrics Society, 7,000 geriatricians are in practice nationwide.

Despite a growing number of seniors, few American doctors go into the field. Two-thirds of graduates in geriatrics are foreign doctors who may or may not stay in this country.

"It's telling you the average American isn't in a hurry to go into geriatrics," said Dr. John Morley, head of SLU's program and a South African by birth. "A lot of young people just don't ... want to work with older people."

Dr. John Campbell, 33, an American like Cummings-Vaughn, became interested in treating older patients during his residency at St. John's Mercy and while helping his wife and her family deal with a loved one's Alzheimer's disease.

"It can be very complicated, but most people went into medicine to be challenged," Campbell said. "Geriatric primary care is very challenging."

Morley went into the field because he was tired of Minnesota's snow and wanted to go somewhere warm. He landed in California. The challenge of treating patients with multiple conditions is what has kept Morley in the field.

"That's what makes geriatrics so much fun," he said.

Part of the field's challenge is the culture gap between seniors and their doctors.

Cummings-Vaughn said most patients she sees don't think she's old enough to be their doctor.

Morley experienced that first hand. He had one case in California where, though he had been able to treat most of their ailments, his female patients complained about swollen ankles. He dismissed the complaints at first, not realizing that ankles were important to the women's self-esteem.

"Turning an ankle," at a time when women showed very little skin, was considered seductive and a way to flirt. That had not been the case for the younger Morley.

"Having lived through mini-skirts, it was difficult for me to understand the importance of the ankle," Morley said.

The incident demonstrated two of the more difficult parts of geriatric medicine to him -- listening to patients and looking at how a small problem can affect a patient's well-being.

Campbell recalled a patient who had, among other conditions, incontinence.

"Those are distressing in themselves, but they really prevented her from going outside, seeing her kids, going to the store and seeing her friends," Campbell recalled. Campbell made treating the incontinence a priority -- and in the process improved his patient's social life.

Sometimes, though, the geriatrician has to tell patients things they'd rather not hear. "One of my major roles is to be nasty and say you can't drive, or you can't live by yourself anymore," said Morley. Many people get upset, but a geriatrician's role isn't to upset people. It's to help treat the ailments brought on by age.

Geriatricians often deal with multiple conditions and may have to undo some of the work of a senior's primary care doctor to improve a person's life.

"Geriatricians spend a lot of time getting rid of meds that are making things worse," Morley said.

One reason young doctors may avoid the field, Morley said, is that salaries are not as high as other medical specialties. Geriatricians may make $160,000 a year. A neurosurgeon or plastic surgeon, Morley said, might make a million dollars or more.

But money shouldn't be the motivator, said Campbell. "If you've gone into medicine for the money, you're in the wrong field," he said.

Retired dentist Norman W. Freiberger was tired of seeing elderly patients with toothaches in the emergency room instead of in a dentist's chair because they lacked dental insurance. With the help of SSM St. Joseph's senior services division and some volunteers, he founded the SSM St. Joseph's Senior Dental Clinic, now in its seventh year. It serves serves low-income seniors in St. Charles, Warren and Lincoln counties.

As people grow older, dental problems increase, but seniors often don't get the treatment they need.

"There are so many of the seniors, the frail seniors, that it gets bumped to the bottom of the list because it isn't deemed as life threatening," said Pam Plumley, head of senior services for St. Joseph's and other SSM hospitals in the area. "But people don't realize how poor oral health affects your overall health."

Toothaches and poorly fitted dentures can lead to seniors not eating enough, causing malnutrition and dangerous weight loss. Infections can enter the body through the mouth and turn into illnesses with serious consequences.

The dental clinic is staffed by eight dentists, two dental assistants and Freiberger. The clinic does not perform bridge or crown operations. It does perform general dental exams, tooth extractions and denture fittings among other services.

The clinic is specially equipped for older people and moves at a slower pace than regular dental offices where patients are treated on a tight schedule. It is equipped for older people with special X-ray machines and dental chairs to accommodate those in wheel chairs. Buses provided by SSM St. Joseph's bring seniors who meet the clinic's income requirements ($25,000 a year singles; $35,000 for married) directly to and from visits, cutting down on the problem of getting people in and out.

The clinic started with a $55,000 grant from the Daughters of Charity, a religious order. Since then, it has been supported by additional grants and donations from private people.

Although those operating the clinic wish otherwise, it can only serve about 1,000 seniors a year from three counties. Plumley said she's received calls from people in other parts of the metro area, but there aren't enough volunteers or dollars to go around.

"People say, 'This is a Godsend, why don't we have more?" Plumley said of the calls, expressing regret about the clinic's limitations. "We don't make money on this, we don't even break even."

"It's just another element of our health system that has failed and isn't working," Freiberger agreed. He would like to see more emphasis on geriatric issues in dental schools because, like their medical counterparts, few student dentists go on to work in geriatric dentistry.

However, Freiberger and Plumley don't see a stop to their clinic's work anytime soon and pride themselves on the service their patients receive.

"I think our real asset is the way we treat the patients," Plumley said. "Dignity and respect, that's what we preach."

Freiberger, who has practiced dentistry for 50 years, doesn't plan to stop soon. In addition to working at the senior dental clinic, he drives twice a week to Vandalia to offer his services to women prisoners incarcerated there.

"In my case, I've just enjoyed dentistry and I don't know how much longer I'll be able to do it," Freiberger said. "But I just want to give back as long as I can."

For more information on the SSM St. Joseph's Senior Dental Clinic, click here or call 636 -947-5037.

How to become a geriatrician:

The Geriatrics Fellowship offered by Saint Louis University Medical School is a one-year program for doctors with an option for a second year focusing on research.

Fellows complete rotations in fields like geriatric psychiatry and hip fractures. They must work at the St. Louis Veterans' Administration Medical Center and work ambulatory rounds.

Additionally, they supervise over 100 patients in two nursing homes.

Saint Louis University's Geriatrics program was ranked in the top 20 programs in the country by U.S. News and World Report.

Amelia Flood is a free-lance writer.

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