Dr. Edmund Duthie is Division Chief in Geriatrics/Gerontology at the Medical College of Wisconsin who spends his time caring for patients at the VA and Froedtert Hospitals in Milwaukee. He practices geriatrics in interdisciplinary settings. He teaches fellows in geriatrics, medicine residents, medical students and PA students. He also participates in clinical research projects that are ongoing in the Division. He received his BS in Chemistry at University of Notre Dame, his MD at Georgetown University School of Medicine, and did his Medicine Residency at Medical College of Wisconsin. He completed his Geriatric Medicine fellowship at the Jewish Institute for Geriatric Care SUNY-Stonybrook.

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

Geriatric patients are the most challenging cases in internal medicine. Patients are grateful for the interest that I take in their care, as are their families. Working as a member of an interdisciplinary team is fun and rewarding as well. I also enjoy the variety of settings where I work: nursing home, clinic, subacute care, hospital, and home care. I find teaching geriatrics is also rewarding and that trainees are receptive to looking at these patients in new ways. The research opportunities are boundless, since we are still trying to answer basic questions that still need to be addressed in aging patients. The field is small and full of terrific colleagues throughout the US. My professional network could not be any finer.

How and when did you decide to pursue geriatrics?

As a senior resident in medicine, I became attracted to a career as an academic generalist. I enjoyed academic medical centers and wanted to be a faculty member at a medical school. My chair, Daniel McCarty MD, took time to counsel me and advised me to find an area of expertise. He was well aware of the development of Geriatrics in the UK and urged me to consider the challenge of initiating a geriatrics program in the MCW Department of Medicine. He put me in touch with a few campus leaders in the field and had me attend a national meeting of academic leaders in geriatrics. I quickly became enthused about this area and the rest is history. MCW sponsored my fellowship in NY at the oldest extant program in geriatrics in the US. It was my great pleasure to have been trained by Leslie Libow MD, a pioneer in US geriatrics and a long time leader at Mt Sinai's Department of Geriatrics. Steven Gambert, a dynamic geriatrician, was my first Division Chief and mentor at MCW. Other terrific mentors have been Donald Tresch, Daniel Rudman, Jim Goodwin as well as my chairs and medicine chiefs at the VA and FMLH. I have also been blessed to work with terrific colleagues at MCW, in my Division/Department as well as outside the Department and medical school.

What are the characteristics that a geriatrician should have?

In my opinion a great geriatrician needs:

• An in depth knowledge of disease and its management
• Knowledge of aging in human systems
• A commitment to the biopsychosocial approach to patient care and management
• Comfort and appreciation of the interdisciplinary approach to patient care
• Patience
• Comfort with uncertainty since frail older persons cannot always withstand intense investigation
• An understanding of our society's youth orientation and fear of aging that results in a devaluation of older persons and those who care for them, ie , a thick skin

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

In addition to core inpatient and outpatient medicine, family medicine clerkships, I would recommend a specific geriatrics elective. This can be done away at a program where the student may be thinking of applying for residency. Our elective for seniors will give the student not only a flavor of geriatrics, but also the entire MCW Department of Medicine. Other good electives are PM&R, geropsychiatry, neurology, home care/nursing home experiences, palliative care, women's health.

Are there any disadvantages to being a geriatrician?

Geriatricians care for the most challenging, complex patients with multiple problems. This can be exhausting at times. The funding for geriatric health care is a constant challenge, given that medicare is the prime payer and limits reimbursement for services. Paper work can also be a nuisance, but I think this is true for all of medicine.

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

Some myths:

• Old people are complainers
• There is little you can do for old frail people
• Geriatric care is depressing
• Old people comply poorly with medical regimens
• Families don't care about their older relatives
• Aging inevitably results in disability