Dr. Carmel Dyer: Many Hats
Dr. Carmel Dyer (on left) and Mary Gleason, MSN, RNC (on right)
Dr. Carmel Bitondo Dyer, M.D. is an Assistant Professor of Medicine at Baylor College of Medicine, Houston, Texas, and the Director of the Harris County Hospital District Geriatrics Program. Wearing several hats in the Texas Medical Center, Dr. Dyer divides her time between clinical practice, departmental administration, research, and multidisciplinary leadership. Dr. Dyer’s recent accomplishments include setting up a ground-breaking multidisciplinary group, the Texas Elder Abuse and Mistreatment (TEAM) Institute, co-authoring a paper on geriatrics as an interdisciplinary phenomenon, and conducting clinical and didactic research in conjunction with area Adult Protective Services (APS). Amit Shah, a graduate of Washington University in St. Louis and first-year medical student at Baylor College of Medicine, had the opportunity to spend a day with Dr. Dyer. After a day of questions and observations, he learned about the myths and realities of geriatric medicine, as well as the fast-paced, multifaceted life of one of Houston’s truly integral physicians. In paraphrased form, here is what Mr. Shah found:
Q: "What is most exciting about geriatrics?"
A: Geriatrics is a wide-open field, offering several tracts for the interested student and physician. Indeed, geriatrics involves anything from working in cutting edge research to being a great clinician to working in public/health care policy. It is a profession in which you can make a difference and leave your mark.
Q: "How did you come to pursue geriatrics?"
A: When I was in college I wanted to get some medical experience. However, the local hospital in town would not even hire me as a volunteer since at that time they had too many. As an alternative, my school guidance counselor suggested that I try volunteering instead at church-affiliated nursing home in town. It worked. The director of nurses took me under her wing and encouraged me to undergo nurse’s aide training. Following her advice, I became a nurse’s aide. While it was the hardest physical labor I have ever performed, I was given time to make rounds with the physician and even observe with him during office visits. Stemming from this experience and a personal admiration I held for my spirited grandmother, who lived independently until her death at 98 (see picture, below), I became determined to pursue geriatrics as a medical career. Accordingly, I attended medical school, did a residency in internal medicine, and finally completed a two-year fellowship in geriatrics.
Dr. Dyer's Grandmother, Josephine Caropreso, Age 96
Q: "What are the characteristics that a geriatrician should have?"
A: Key characteristics are patience and compassion. Patience is necessary because older adults move more slowly, and they carry around a patient history spanning 80 years or so that must be carefully traversed in the interview. Also, geriatric medicine requires time to build trust with your patients to the point where they feel comfortable talking to you about sensitive issues, such as some of the psychological problems they may be having.
Q: "Are there any specific rotations/internships that you would recommend for medical students who are interested in geriatrics?"
A: Students should, first and foremost, take elective courses that are interesting to them. Naturally, a sub-internship in Medicine is always a good thing to do. However, another one that is often overlooked that is useful is podiatry.
Q: "Are there any disadvantages to being a geriatrician?"
A: Geriatrics is a very demanding profession characterized by complex cases and somewhat lower compensation than other medical practices. Further, most geriatricians "wear more than one hat." If this is not what you want, geriatrics may not be the profession for you.
Q: "What are some of the myths about geriatrics and geriatric patients?"
A: The number one myth is that we don’t help anyone and that geriatric patients never get better. On the contrary, I can do something subtle for a patient, and it can have a huge impact on their life. For example, looking at the patient’s medications and realizing that two of them may be interacting and fixing this is a simple, yet beneficial change. Another example might be talking with a patient and realizing that they are suffering from depression that they thought was just a part of "getting old." Pursuing this observation with treatment changes their life. Further, it is not only the medical things you can do— you treat someone with a lot of respect, and they respond to that. You can see the change in self-esteem, which is such a critical issue in the elderly.
Q: "I think another common misconception is that geriatrics is depressing, or that all your patients die on you. Is this true?"
A: That is a big misconception. It is not true that all your patients die on you or anything like that. There are patients that I have been seeing for years. There have been numerous studies about the efficacy of geriatrics—and they have shown that geriatric assessment and intervention increases greatly the quality of life of patients. Good geriatric care results in patients being able to often go back to their independent lives. Truly, these patients are so great—they shower you with so much love. There is nothing I find depressing at all about working with older people.
Do you have any other questions that you'd like to ask Dr. Dyer? Looking for some advice? She'd love to talk to you. Her e-mail is cdyer@bcm.tmc.edu.
