Physician at Work: Gerontologist treats the whole patient
The goal isn’t always living longer, it’s living better
Thomas Gill, MD, chose to practice geriatrics because he enjoys taking care of “the whole patient.” He also likes that the specialty provides a broad perspective on a group of people whose goals are often different than those of their younger counterparts. “Older persons don’t necessarily want to live longer, they want to live better,” he said.
When Dr. Gill was in medical school, patients were considered old by age 65. But that is changing as people live longer, healthier lives, with higher expectations for quality of life than previous generations. Today, 75 seems to be the age at which people are considered geriatric, and the ceiling continues to rise. “It’s especially challenging when we are taking care of patients who are in their 90s and their children are in their 70s, because there is more than one generation within the geriatric age group,” he said.
Dr. Gill tries to weigh the benefits of treatment options for older patients against the risks, since approaches that were effective earlier in life may not work as well as a person ages and often come at some cost. For example, anticoagulants that thin the blood are often used to treat atrial fibrillation, a common type of heart arrhythmia. But older patients may have trouble with their gait and balance, so reducing the likelihood of a stroke may be outweighed by the increased risk of internal bleeding from a fall.
They may be less willing to accept treatment to prevent some future event if it means increasing the risk of short-term adverse events,” said Dr. Gill. He focuses on helping his patients sort through multiple chronic conditions and medications to determine the best approach for their particular circumstances.
Sometimes he finds it’s more important to concentrate on the big picture – such as whether a patient is capable of living alone—as opposed to details like specific medications or laboratory tests. “We try to focus more on the forest than the trees,” he said.
Dr. Gill cares for patients in a variety of settings and works closely with other clinicians, using the questions that come up in his clinical practice to inform his research on the process by which older people lose their independence and how to facilitate their recovery. He recently ran across a patient in the Acute Care for the Elderly Service at Yale-New Haven Hospital who is a participant in a study he is conducting.
The Lifestyle Interventions and Independence for Elders (LIFE) study is designed to prevent or delay mobility disability in older adults through either physical activity or a series of successful aging workshops. The patient assured Dr. Gill that he would return to the program as soon as he was able. “It was one of his highest priorities, despite his acute illness,” said Dr. Gill. “It made a strong impression on me that this study is having benefits on an individual basis and could be very important for this patient’s future health and well being.”
Name: Thomas M. Gill, MD
Title: Director, Yale Program on Aging
Areas of clinical expertise: Memory loss and dementia, geriatric assessment, frailty, functional decline and disability
Areas of research expertise: Functional assessment, epidemiology and prevention of functional decline and disability, clinical trials
Place of birth: Chicago, IL
College: Loyola University, Chicago
Med School: Pritzker School of Medicine, University of Chicago
Training: Intern and resident, Primary Care Internal Medicine, University of Washington; postdoctoral fellow, Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine; postdoctoral fellow, Geriatric Medicine and Epidemiology of Aging, Yale School of Medicine
Family: Wife: Colleen, a physical therapist; Children: Connor, 16, and Jack, 11
What is the most important thing you’ve learned from your patients?
The importance of maintaining independence as one gets older and of not being a burden to your children.
What was the biggest challenge you ever faced as a physician?
Maintaining my clinical skills and knowledge while leading a very active research program.
How have your experiences with patients changed your approach to care?
I do a much better job of keeping the big picture in mind, while attending to the immediate needs of my patients.
Personal interests or pastimes?
Time with my wife, running, theater, attending sporting events with my sons (even the Cubs!)
Last book read:
The Screwtape Letters by C. S. Lewis