Dr. Patricia Lanoie Blanchette is Professor and Chair of the Department of Geriatric Medicine at the John A. Burns School of Medicine at the University of Hawaii. In 1974, while a medical student, she founded AMSA's Task Force on Aging, which continues today as the Geriatrics Interest Group. She graduated in 1979 with a combined M.D. and an MPH in Gerontology from the John A. Burns School of Medicine. She then did an internship and residency inInternal Medicine at the Dartmouth-Hitchcock Medical Center from 79-82, and a fellowship in Geriatric Medicine from 82-84. She is boarded in both Internal Medicine and Geriatric Medicine.

In 1984 she was recruited back to Hawaii to found the medical school's first Geriatric Medicine Program, recently raised by the school to full department status. Hawaii now has the fourth Department of Geriatric Medicine in the U.S. (Other departments are located at Mt. Sinai in NY, Arkansas, and Oklahoma.) In 1986 Dr. Blanchette founded the school's Geriatric Medicine Fellowship Program which now has a total of 12 fellowship positions. Dr. Blanchette is also President of the Hawaii Chapter of the Alzheimer's Association, and a member of the national Alzheimer's Association board, serving on the Public Policy and Diversity/Inclusion Committees. She is the Governor of the Hawaii Chapter of ACP-ASIM, Chair of the Hawaii State Board of Medical Examiners, and medical director of three nursing homes.

Her main interests are in medical education, medical and medical school administration, long-term care administration, clinical geriatric care, and aging research. She serves as a member of an interdisciplinary research team with a main focus on chronic disease epidemiology. The team is especially interested in discovering risk factors that can help eliminate poor health in old age.

What is most exciting about geriatrics; what makes it unique?

Geriatric Medicine is both academically challenging and clinically satisfying. Opportunities abound for every well-trained geriatrician. Research in aging is overturning one myth after another about old age. We are living through an age of great discovery with regard to aging. There are contributions to be made in every aspect of the science of aging, for example in the interplay of multiple genetic factors and environmental exposures. It is also the area of medicine which has the greatest need for physicians in all areas: primary care and consultative medicine, research, education, and administration. It is satisfying to be fulfilling a great need. This is not an area where physicians compete with each other for "desirable" patients. There is so much that needs to be done, where one person can make a significant difference.

In geriatrics today, we are living through and participating in the development of a new field of medicine, much like pediatrics in the 1930's. Programs and departments are developing in medical schools and medical centers, and more people are seeing the need for the administrative structures and funding that are necessary to meet the needs of clinical service and training.

One interesting thing about geriatrics is its interdisciplinary nature. Most people working in geriatrics work as part of a formal or informal interdisciplinary team. Also, there is a lot of contact with families, family counseling, and consideration of the older patient both as an individual and as a member of a family or residential care unit. It's a different way of thinking that usual adult medicine.

ith a goal of healthy old age, there is also a great deal of interest in prevention and in secondary prevention. So many of the painful and serious conditions in old age, such as osteoporotic fractures and strokes, may be entirely preventable. Those who have an interest in Public Health, in the health of populations, might be naturally drawn to the field of geriatrics. With the great successes that have been obtained in the control of infectious diseases, the great challenges in Public Health remain the prevention of diseases that affect the quality of life in old age.

Anyone who thinks geriatrics is depressing has never done it. Older people are amazing in their array of personal qualities and in their life histories. While not minimizing the great sadness and loss that can occur in old age, there are also great satisfactions, a resiliency of spirit, and a sense of humor which must be prerequisites for reaching advanced old age.

How and when did you decide to pursue geriatrics?

I was raised in a family which greatly respected its older people. Grandparents and great aunts and uncles were formidable people who had immigrated from another country and established a thriving family in the U.S. The only doctors that I remember seeing where the doctors who cared for older people. I grew up thinking that all doctors were geriatricians. It was one of those funny misconceptions of children. When I decided to become a doctor, I was amazed that Geriatric Medicine was such a new field, and that there were so few schools where it was being taught. As an AMSA member, I decided that I would try to talk to as many leaders in the field as I could, so I traveled to visit leaders such as Dr. Leslie Libow who was in Long Island, Drs. Jack Rowe and Richard Besdine at Harvard, and Dr. Joe Freeman in Philadelphia. I also met with Dr. Robert Butler who was the first director of the National Institute on Aging. I also had the great luck to be invited to join a group visiting China led by Maggie Kuhn, the founder of the "Gray Panthers." Being with her and her group for a month just about nailed the decision. Just to be sure that I hadn't made a career choice too early in my training, I "tried on" every rotation as though I were going to do that for life. I role played being the pediatrician, surgeon, cardiologist, OB-GYN, hematologist, etc. It was a mind set that helped me learn so much about the work of physicians in those fields, and also made for very productive and interesting clerkships. I talked to as many physicians as I could about their fields. This helped me decide that geriatrics really was for me, and I've never been sorry.

What are the characteristics that a geriatrician should have?

I see the true geriatrician as a "Renaissance physician," interested in virtually every aspect of medicine. Older people present with a great variety of medical problems. Atypical and subtle presentations are common. There is a need to order priorities, and to understand the interplay of numerous factors. Often there is a need to go beyond the patient to look at family and social factors, and to be comfortable in both arenas. A pioneering spirit, determination, the capacity for working within a system to change it, tolerance, patience, and an undying curiosity are all very helpful. I also believe that in medicine, not just in geriatrics, it is very important to treat every single patient with a full and equal measure of caring and attention. No one is ever more deserving than another of our full consideration.

Are there any specific rotations/internships that you would recommend for medical students who are interested in geriatrics?

I would definitely recommend a rotation in Geriatric Medicine either at your own school or at another medical school. A Summer scholarship program is available through AFAR, sponsored by the John A. Hartford Foundation. (see link to AFAR). If a rotation is not possible, visit as many geriatrics programs as you can, and take advantage of the AMSA GIG activities. If you can attend a meeting of the American Geriatrics Society or the Gerontological Society of America, do it. Both organizations have student groups. Approach the geriatricians who attend these meetings and let them know of your interests. You may be pleasantly surprised at the quality of the attention that you'll receive. Everyone likes disciples.

As for other rotations, some of the most useful would be Geriatric Psychiatry, Rheumatology (focus on osteoarthritis and RA), Endocrinology (focus on diabetes, male and female osteoporosis, and thyroid disorders), noninvasive Cardiology (focus on Geriatric Cardiology and physical diagnosis), Neurology (focus on strokes and dementia diagnosis); GYN (focus on outpatient problems of older women); Orthopedics (focus on hip fractures and outpatient physical diagnosis); Physiatry/Rehab Medicine (focus on physical diagnosis, prevention of falls, and rehab in older people). Training in family counseling with a focus on multigenerational families would be very helpful. If there is an area of science that you find fascinating, a very good use of your time would be an elective in which you could focus on the aging research aspects of this field. Areas of active research pertinent to aging include Epidemiology of Chronic Disease, Genetics, Biochemistry (esp. Neurochemistry), Physiology, and Pharmacology.

Are there any disadvantages to being a geriatrician?

It is difficult, if not impossible, to succeed financially in an office-based private practice. Reimbursement rates are very low and older patients take more time than younger patients. Another disadvantage is the great need for geriatric care, and the feeling that there is always more to be done. Geriatricians need to pace themselves and to build programs around them. Otherwise, "burn out" is a real possibility.

On the other hand, salaried positions abound in medical schools, large medical centers, the VA, HMO's, pharmaceutical companies, and others. The value of Geriatric Medicine is rarely seen in term of patient revenues. Rather, a well-organized geriatrics program improves outcomes and patient satisfaction, while saving money for the organization overall. Our fellows often get job offers very early in their training, and usually have several attractive opportunities by the time they finish their training.

What are some of the myths about geriatrics and geriatric patients?

I think the greatest myth is that geriatrics is depressing. Beware the geriatrics program, clinic, or residence where there is not a lot of laughter. Old people are wonderful. They are just us in a few years, with all of our foibles and baggage, but with the resilience and honesty that survival into old age requires. It is very depressing to go into a nursing home, especially unescorted and green. But working in one every day soon reveals that they are "small towns" with great personalities. It would be equally depressing to walk into a facility caring for handicapped children without a proper orientation and introduction. Sure, Alzheimer's disease is hugely depressing, but so are many other diseases, and this is an area of great research potential. Just think of the possibilities in a world without Alzheimer's Disease.

Another myth is that it is normal to get forgetful in old age. Forget it! It's normal to stay normal. Anything else is ripe for research and intervention.

Another myth is that geriatrics is only for frail elders. More and more healthy middle-aged and older people are seeking out geriatricians for primary care. A frequent comment is that people want to stay healthy as they get older and believe that a geriatrician will help with that. They may be right!

If you have questions for Dr. Blanchette, you can e-mail her at Pblanch944@aol.com. For questions about the Hawaii fellowship program, contact Dr. Kamal Masaki at kamal@hhp2.hawaii-health.com.