As part of our “Meet Yale Internal Medicine” series, today’s featured physician is Andrew Cohen, MD, DPhil, assistant professor of medicine (geriatrics).
Andrew Cohen, MD, DPhil, completed a doctorate in English before heading to medical school.
“I come from a medical family. My father is a rheumatologist and my mother was a nurse,” explained Cohen. “And for that reason, I thought I would pursue something else, but I have been always drawn to medicine partly because of the way it intersects with society and with a lot of big questions about what constitutes quality of life. Also, it's deeply rewarding to make a difference in an older person's life. I find that to be an incredibly wonderful part of this job.”
Cohen completed his undergrad in English at Yale University, but ventured to Oxford for his doctorate and then to Pennsylvania and New York for his medical school and residency training. He returned to New Haven and Yale School of Medicine (YSM) due to his love of the university and its host city to complete his fellowship.
He gravitated to geriatrics as a field partly from a clinical interest in older patients and the complexities of caring for them, but also because he’d recognized during his residency that there was so much to learn about how to best take care of older patients.
“Yale Geriatrics has an incredible faculty, which was apparent when I was looking at fellowship programs,” said Cohen. “When I came here, I knew I wanted to do research, but I was also interested in different aspects of clinical care for older patients. We're taught in medical school to think about individual diseases, but in reality, most older patients have numerous diseases. Oftentimes what you want to do to care for one disease can have a negative effect on another one, or create a whole new problem for a patient.”
While an intern, Cohen came across the article, “The End of the Disease Era” by YSM’s Mary Tinetti, MD, and Terri Fried, MD. Cohen admits that he wasn’t familiar with either physician at the time, but the article had him thinking that the disease-focused model of care “falls apart when we think about older patients.” He was persuaded to learn how to think about medicine differently.
I've always been interested in non-medical factors that are important to the health and well-being of the person. Geriatrics is one of the subspecialty fields within internal medicine that is deeply interested in those factors. We think about the home environment, and how it can be modified to allow somebody to stay successfully there. We also think about the importance of social contact on health and other factors outside of what you might see in a medical textbook.
Dr. Andrew Cohen
“I've always been interested in non-medical factors that are important to the health and well-being of the person,” said Cohen. “Geriatrics is one of the subspecialty fields within internal medicine that is deeply interested in those factors. We think about the home environment, and how it can be modified to allow somebody to stay successfully there. We also think about the importance of social contact on health and other factors outside of what you might see in a medical textbook.”
One area of interest for Cohen is studying medical decisions made by conservators, or people appointed to choose a course of action for a patient without a friend or family member to represent them. He is also driven by the important ethical questions about how to make decisions for patients who have dementia. He knows these conversations can be hard amongst loved ones, but sees them as necessary.
“Ordinarily, much of the thinking around advance care planning and advance directives is with a disease where patients are able to make decisions until nearly the end of their lives. But the real challenge with dementia is that people can lose capacity to make medical decisions years before they reach the end of their lives, and there may be a long period where other people will need to represent them.”
In addition to treating patients at Yale New Haven Hospital, Cohen participates in the Department of Veteran’s Affairs program called Home-Based Primary Care. He visits homebound patients throughout New Haven County. In conjunction with caring for patients, Cohen is also working with other investigators to design advanced care planning around a patient with dementia, the patients he currently advocates for through his work.
“It is important for societies to protect their most vulnerable people,” explained Cohen. “None of us really knows how life will go for us but would want to be treated in the best way possible no matter what.”