09.18.2007

Dr. Jeffrey Burl, Medical Director of The Overlook campus, walks the corridors of the Overlook Masonic Health Center at a brisk pace. His light blue shirt has the sleeves unbuttoned and rolled up around his forearms; a stethoscope dangles from around his neck. Two young doctors follow closely behind as he barks out scenarios.
“A woman rejects her medication, what do you do?”

“We reason with her and tell her why it’s important,” one of the young doctors responds.

Dr. Burl chuckles, “She is suffering from severe dementia; you cannot have a ‘reasonable’ conversation. What do you do?”

“Ummmm,” is the immediate response. One looks at the other. The other looks at the floor. “Contact her family…”

“You can’t get a hold of them.”

“What medication is she taking and what will happen if she doesn’t immediately take it?” one nervously asks.

For nearly five years these types of conversations have echoed through the halls on Friday mornings throughout the Charlton campus. As soon as the American Board of Internal Medicine said that all general internal doctors must go through a rotation of geriatric training, Dr. Burl leaped at the opportunity and offered the Health Center for one of their training facilities. Approximately one hundred interns have now been trained in gerontology at The Overlook.

A fresh group of interns from St. Vincent’s Hospital in Worcester come to Charlton for four three and half hour sessions over the course of a month and the experience can be eye-opening and emotional. “We normally only see patients who are advanced in age when they are acutely ill,” said Ernest Dinino, one of the interns. “It’s remarkable to see them here at this stage of their life, happy and in great spirits.”

“We get to see another side of the quality of life that people can enjoy at these advanced ages,” added Robert Palusinski, another intern. “That helps so much in the care of individuals. We have a benchmark to understanding their recent health and abilities which helps guide us to leading them back to what they are capable of being.”

Unfortunately, the study of gerontology is neither popular nor profitable. The payor systems that are currently constructed compensate highly for high-tech solutions to problems whereas gerontology is very much based on one-on-one consultation and personalized care. One of the great frustrations is the realization that this is not a new phenomenon or issue in medicine. There is documented evidence which reaches back to the 1940s and 1950s which discusses the oncoming senior boom and the need for an increase in gerontology training. Still, roughly only 2% of all medical school graduates will specialize in gerontology.

“Gerontology is just not flashy enough for most students coming out of medical school,” said Burl. “In cardiology, for example, you can fix something. There are immediate results and gratification. In gerontology the best we can do, most of the time, is keep the demon at bay. There is no cure for old age.”

The inability to “cure old age” is actually far more of a problem than what would initially be viewed as a witty comment. “The fact is,” said Palusinski, “the current medical system pays for finding cures for diseases, not for helping to teach people to lead healthier lives. Maybe ancient China had it right when they compensated doctors when people were healthy and not when they became ill.”

With the overwhelming numbers of seniors currently in this country and the numbers that will be added to this list as the Baby Boomers continue to age, what does the future of senior care look like? “It’s a crisis situation,” said Dr. Burl. “There certainly will not be enough gerontologists so we, as a profession, have to ensure that all of our general internal medicine folks are being trained in gerontology. The question we continually face is how to bring the core principals of geriatrics into other specialties. Like it or not, the job of almost all doctors is caring for an older population.”

Discoveries of cures or controls of infectious diseases; public-health measures; surgical procedures; and rehabilitation have afforded the world more older people than at any other time in our history. At what cost, many ask. What good are additional years if they are spent suffering from degenerative diseases? Who amongst us would choose to regress to the point where we have little more control over our lives than an infant, needing to be diapered, bathed and fed? Could we push the bounds of development so far that we, as an aging population, turn into a burden to our families and society?

“The opportunity,” explains Burl, “is not adding years to life as much as it is adding life to years.” This is what the majority of the newly anointed doctors are missing, the opportunity to extend the good years for an individual as opposed to extending the frail years. While the new frontiers that we are exploring in age are bringing additional medical, physical and socio-economic challenges, the landscape is also changing for growth, development and our abilities to make a difference well into our “senior” years. Not to mention the opportunity for society to tap into a reserve of knowledge that is greater than what we have ever experienced before in our history.

Our industry challenge is to get doctors to look at gerontology the same way they look at pediatrics. It is an opportunity to assist a population to understand how to live as healthy and fulfilling a life as possible. Pediatrics, most of the time, makes healthy children healthier; gerontology will make aging people healthier. This will decrease their dependence on others, allow them the potential to continue to lead active and engaged lives and help solve major healthcare issues before they become crisis situations. Babies are not simply young adults and the elderly are not simply old adults. They each require their specialists. Dr. Burl will continue to bring interns through the different levels of care that are provided on the grounds of The Overlook Life Care Community with the hope that these new young specialists will realize the tremendous value they can lend in improving the latter years of an individual’s life.

Published in the Trowel-Fall 2007