Which Physician Should We Choose, Mom?

When your senior parents or grandparents complain of achy joints or a palpitating heart, avoid calls to every medical specialist in town. Most likely, the physician she normally sees will suffice.

With the introduction of geriatric medicine, who should you call when your senior parents or grandparents have health problems? Geriatricians may be good choices for some people over age 65, but not for all.

"The most appropriate physician for seniors is the one who has the most empathy, compassion and understanding of their illness," says Dr. Milton A. Guerrero, a geriatrician at the Memorial Geriatric Resource Center, MGERC.

"You do not need to be a specialist to provide proper care to older patients. A visit to the physician, whether family practitioner, internist or geriatrician, who feels comfortable with medical and psychosocial issues of older adults is a good choice," Dr. Guerrero explains. "Frail older patients who exhibit cognitive, functional and medical problems are usually cared for by a geriatrician."

Patients who have familiar complaints such as joint pain or congestion, should always first visit the physician most familiar with their care, Dr. Guerrero says. Those who have had heart problems should return to the cardiologist who was initially trained in internal medicine. Patients recovering from a stroke however, should seek the care of a neurologist and later return to an internist or family practice physician.

Geriatricians have expertise in caring for multiple issues that are prevalent among older adults. Trained extensively in the multidisciplinary approach to health care, they understand the importance of input from other professionals such as therapists, nurses and social workers.

It is not until older patients become frail, exhibit cognitive, functional and medical problems that they should be cared for by a geriatrician. Dr. Guerrero advises most of the functional, older adults to continue visiting their primary care physician until told to seek the expertise of a specialist.

Patients at MGERC are given a comprehensive geriatric assessment to determine their health, nutrition and cognitive status. They are also given an environmental screening to determine their daily living routines and safety. The tests help the physician determine the patient's level of independence.

"Everyday, there is something rewarding about geriatric medicine that keeps me going," Dr. Guerrero says. "I see more appreciation shown by these patients and their families than I have ever seen. When patients are young, they have a stronger tendency to take the physician's care for granted, but not these patients."

Dr. Guerrero says unfortunately, there is strong mistaken belief in the community that older adults do not get better and therefore should expect the pain, depression or sadness to be a normal part of life. "That is not reality," he says. "We can help them feel better about themselves and not live in pain. We are always making an impact on our patients quality of life."

With the number of older adults growing at such a fast clip in the United States, more and more are advancing in their careers to become chief executive officers, senators and other high-ranking authorities. But they too will one day become unable to perform at their current levels. Many will likely need the care of a geriatrician. Dr. Guerrero estimates there are approximately 8,000 geriatricians nationwide, when the need is projected at 20,000.

"In reality, not all older patients need us," Dr. Guerrero says, "but for those who do, making the right choice can make a significant difference in their lives."

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©2006 Texas Medical Center

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