Aging Well

What is a Geriatrician?

What distinguishes a geriatrician from a regular internist and when should you seek the help of one?

Posted Updated
Dr. James Parsons
By
Liisa Ogburn

It wasn't just one or two people who asked me if I knew Dr. Parsons, an old school physician and geriatrician who has practiced medicine for almost 40 years, caring not only for older patients, but in some cases, up to three generations within a single family. He set up an office in downtown Raleigh in a non-descript, single-story building at 704 West Jones Street in 1979 and also stepped into the position of Medical Co-Director (with Dr. Billy Dunlap) of Mayview Skilled Nursing in Five Points.

Dr. Parson's waiting room has a large roll top desk and a corner display, showcasing medicinal bottles through the ages that patients have brought him. I followed Dr. Parsons down the long hallway that led to his wood-paneled office. The walls were covered by various degrees, photographs and honors. He had a knee-high pile of thick patient charts beside his overflowing desk. "I saw all those this morning," he said. He sees patients in this office from 8 am to 3:30 pm on weekdays, then goes over to Mayview most afternoons, where he oversees the care of 60 long-term care residents.

  1. What is a geriatrician?
A lot of physicians see geriatrics as taking care of people over the age of 65. To me, geriatrics is taking care of the debilitated elderly. If I see an 80-year-old guy who goes to the YMCA every day and runs two miles three times a week and is very, very healthy, I’m seeing him as an internist. On the other hand, if I have an 85-year old guy whose had a stroke, is impaired and is struggling to live at home so he doesn't have to move to institutional care, that’s where I am a geriatrician. I don’t just see elderly people over 85. I see their children, and in some cases, their grandchildren. That way you can understand the family dynamics and how everything ties in to health.
  • How did you become a geriatrician?
  • In 1970s, there was no formal geriatric training program. Of all the geriatricians in my generation, you just had a knack for taking care of older people. Each patient is complex. It takes a long time to see them and it's a low reimbursement rate. If you don’t love it, if it’s not in your heart, then taking care of older people will drive you nuts.
  • What is the training for a geriatrician?
  • Geriatricians go through four years of medical school, then generally three more years of residency in internal medicine, and then an additional one to two years of a fellowship, before taking an exam to be "boarded" in geriatrics.
  • What distinguishes a good geriatrician?
  • Most physicians generally do everything according to clinical practice guidelines. For any given problem, there’s an algorithm. Step one, step two, step three… Unfortunately, when you have old people with multiple problems and need to follow multiple clinical guidelines, you have disastrous results. You absolutely have to think outside the box. You cannot treat a 90-year-old person in exactly the same way you treat a 30-year-old one. For example, you can’t put old people off more than a day. We have to treat them more aggressively because they can quickly go down the tubes.
  • What is one of the most helpful things you do for your patients?
  • Whatever success I’ve had as a physician for my older patients, it's because I have helped reduce some of the many meds people come in on. Truly, the miracles I've performed have been simply because I've discontinued medication. It's amazing the spectrum of people that end up, especially in skilled nursing, who are on as many as 35 different medicines. I mean if you came to my office and said you had a problem and I said, "here take these 35 pills," you would leave and say that guy is a quack.
    Another important part of the job is dealing with the families. Some adult children think if we can just find the right pill or doctor, our 95-year-old mom will get better and live forever. You hear that the vast majority of Medicare dollars are spent during the last 18 months of life. People are going through multiple hospitalizations and multiple interventions and not getting any better. In fact, the extensive testing may even be detrimental. I think somebody needs to say, "Let’s pull back. Let’s focus on function, on comfort and providing a good living environment, and support services instead of a cure."
  • How do you find a geriatrician?
  • That's a good question. There are only 6000 geriatricians across the country, most in academic settings. Every year, there are probably 200 who graduate from geriatric programs and 200 of us retire or die. I refer people to the UNC system. Duke also has a very good department of aging and a geriatric evaluation team. That would be a place to get an evaluation and maybe they could help you find an internist near where you live.
  • Any other advice?
  • I tell families, "Rather than focus on a diagnosis and treatment, look at how your mom is living. What is her quality of life, her functional status? What can I do today to get her functional status better so she can function better at home better rather than sending her off to more CT scans so a doctor can give her three pills that may or may not help?"
    A lot of times when these elderly folks come in with complex symptomatology, I don't hesitate to tell them I have no earthly idea what is going on, but they would be much better off to live with it than try to intervene. I don't think there's a week that goes by when I don't say my treatment of choice would be doing yoga or tai chi. This would have a much higher chance of improving their functional status than a handful of pills.

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