Issue link: https://tmcpulse.uberflip.com/i/1022543
T M C » P U L S E | S E P T E M B E R 2 0 1 8 12 Spotlight CARMEL BITONDO DYER, M.D., is a voice for the older patient population. At The University of Texas Health Science Center at Houston (UTHealth), she is the founder and executive director of the Consortium on Aging and a professor of geriatric and palliative medicine at McGovern Medical School. She was a delegate to the 2005 White House Conference on Aging and has twice provided testimony to the U.S. Senate on behalf of vulnerable elders. Dyer spoke with Pulse about the challenges of geriatric care and her passion for helping people age. Q | What led you to geriatric medicine? A | It was really two-fold. One, I had this incredible Italian grandmother who lived to be 98 years old. She was still living alone when she died, and she was just really a great inspira- tion to me. She had been a seam- stress in the sweatshops of New York City. She designed wedding gowns. She was amazing. I also had an opportunity when I was a senior in college. You know how you have to get medical experi- ence to do medical training? I was in a small town—DeLand, Florida—and there were no volunteer jobs, so the school guidance counselor hooked me up with one of the local nursing homes. The director of nurses took me under her wing and she put me through nurses' aide training. She had me round with the geriatrician, and I just thought this was a tremen- dous career. Q | Was there anything in particular that has stayed with you from that experience? A | We saw these people in very late age, and I remember there was a gentleman who had problems with dementia. When he passed away, they handed us a one-page biography of all the contributions he had made on the national front and locally. I thought, 'We missed this. We missed it. We saw him in his late age, but he had a whole lifetime of contributions.' I thought, 'That's what should come first when you meet somebody. You're only seeing a snapshot of them when you see them when they're elderly. You don't know all the things that they have done in their life.' Q | Why do you think there is a shortage of geriatricians in the United States? A | Unfortunately, geriatri- cians deal mostly with Medicare. Medicare reimbursement is based on volume. With elderly patients, you have to spend more time. As a result, geriatric medicine is the only field where you can get extra training and earn less money. I think that's why. I also don't think that everyone realizes what a differ- ence the expertise makes. Here's why: Back when MD Anderson was started and Texas Children's Hospital was started, the average life expectancy was 68 years of age. Now, it's pushing 80. The textbooks have not caught up, and the training we get in geriatrics is really targeted toward the frail elderly. Q | Is that why you are leading an initiative to create a geriatric hospital? A | There is a lot of dissatisfaction in the public with the health care system when you're of an advanced age. We are not equipping health professionals with what they need. If you only get a month of training in geriatrics in internal medicine in medical school, that's not enough. Both Baylor and UTHealth teach geriatrics, but many medical schools do not teach it at all. I'm a geriatric specialist, so people send me the more challenging cases in that regard, but there's a big quality gap and there's huge room for improve- ment. I see the costs escalating and health care taking up a greater