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A doctor doing house calls??? In this day and age? And a geriatrician too? Tell me more!

As a "newbie" to the world of entrepreneurship, many people ask me what my business is about- what it is that I offer that is so needed out there? 

It's made me think...a lot.  And I think the best way to answer this question is to reflect on who I am and why I started this venture at this stage of my career. 

I'm a geriatrician...a doctor who specializes in the care of older adults- from the healthy & robust to the medically frail and declining.  It's a specialty of internal medicine requiring further training after a residency to learn about the intricacies of aging and the older adult.  What I loved about it from the beginning is that it doesn't focus on one specific organ system like the heart or kidney or brain.  It forces you to think about the whole body and all of its organ systems, how they interact, and how they change as we get older.  But- it's even more than that.  It's a field that calls on you to assess and incorporate a patient's mental/cognitive status, social/emotional status, physical functioning & ability to care for themselves, family histories and dynamics, medications, home environments, communities and social networks, and most importantly- their goals and priorities at this stage of life.  It's holistic medicine at its best.   

As you can imagine, this is not a very popular field in medicine- most medical students and trainees do not pursue a career or further training in geriatrics even though they will see older adults as part of their practice no matter what they do- the orthopedist, the cardiologist, the neurologist, the gynecologist, and yes- even the pediatrician who may see an older adult who is a caregiver for grandchildren or others.   

Why is it not popular?  Simply put, it's not "sexy."  Geriatrics is old-fashioned medicine- assessing the whole patient, getting to know them and their caregivers, and designing individualized interventions that tend to be relatively simple- not high tech or "cutting edge."  Geriatricians tend to go with what has been "tried & true," and withstood the test of time.  And there's also the fact that many of our patients are usually excluded from the medical studies looking at the high tech or cutting-edge interventions or treatments because of their complexity- it could throw off the results of the study.  

And furthermore- geriatrics is hard.  You have to deal with decades of built-up medical illness and psychosocial issues- including complicated family dynamics.  You must deal with ageism- within yourself, amongst your peers & colleagues, and in society as a whole.  You have to figure out how to advocate for a patient who is getting lost in the system and whose voice is no longer being amplified.  And you have to do all of this within the limitations imposed by our current healthcare system's structure- short office visits, even shorter hospital visits, and horribly low reimbursement rates compared with our other peers & colleagues in different specialties.  In our current state of medicine, you are reimbursed & rewarded more for spending less time & prescribing a pill or intervention than for sitting down to tease out the multitude of interacting issues and develop a plan of care that makes sense to the person sitting in front of you. 

So, after 22 years of practice- hospital based, office based, nursing facility & assisted living facility based, and house call based, I decided to make a change, to "go my own way."   

I love geriatric medicine.  I love getting to know older adults and their caregivers.  I love putting the many pieces of various puzzles together to help them make sense of what is going on and realistically look at what is coming down the pike.  I relish the satisfaction and ease of mind that I see in their and their loved ones' faces after a difficult conversation that ends in clarity and comfort.  And I love doing this unfettered by time, reimbursement concerns, and in their homes where you get to know the patient the best- on their terms. 

And so, I started this practice.  I operate outside of the realm of insurances, including Medicare.  I see patients in their homes- my office is my car & laptop.  I have unlimited time to spend with them to manage their medical, cognitive, functional, & psychosocial concerns.  When they or their caregivers call the "doctor's office," they reach me- directly.  I can help them translate medical issues, communicate with their other doctors, work through goals of care conversations, answer their questions, and help put an end to the revolving door of hospitals/nursing homes.   

I look forward to sharing my thoughts on geriatrics & how I can help as I move forward in this venture and welcome your thoughts as well- let's make this the start of a great journey that brings value and peace of mind to the older adults in our communities who have contributed so much to make us who we are today. 

Come with me at Geriatrics Planning & Solutions- let's be the "GPS" to help older adults navigate to better health! 

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