A Look Into What I Envison

Medicine

Life expectancy is increased to where the World Health Organization (WHO) estimates that it will certainly exceed age 80 in developed countries. In the United States alone it is estimated that the number of older adults will double by 2060 reaching almost 100 million.According to the US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) Database over 50% of new malignancies are diagnosed in those over the age of 70. Age however is no longer found to be an independent factor in poor outcomes. In fact the old paradigm of the elderly patient with cancer is changing. Older adults are more variable with regard to their co morbidities and physiological reserve. Simply judging someone by their chronological age instead of taking of comprehensive view is depriving families and their loved ones effective treatment options that do not necessarily have to reduce quality of life and can still improve progression free survival. Newer options such as Immnunotherapy, intensity modulated radiation therapy and targeted therapy have been shown to have a tolerable side effect profile. Nonetheless, there is no universal treatment modality that can be applied to all older adults as this group of patients have unique challenges. These challenges go well beyond the basic co morbid conditions that can be present in almost any average individual. It includes the added pressure to examine the variable of age on both physical and neurocognitive function. The science of aging is a very complex interplay between different molecular and physiological processes which are still not completely understood as some patients undergo what we call “healthy aging” while others do not. That is why an individualized approach needs to be taken to each older adult diagnosed with malignancy. Treatment can be tailored based on careful evaluation using the principles of Geriatric Medicine. Simply relegating older adults diagnosed with malignancy as cases suitable for palliative care without full consideration for tailored treatment and support options is no longer acceptable. However, the converse is also true, over aggressive treatment with cytotoxic agents used in the general population can lead to very poor outcomes. Treating the “disease” as opposed to treating the patient can have dire consequences on quality of life. This can render older adults with severe disabilitieswhich often leads to more psychosocial stress then the original diagnosis itself. Geriatric Medicine akin to Pediatric Medicine involves the input and counseling of families who play an integral role in the patient’s lives. This may also involve careful decision making regarding advanced directives and goals of care where ultimately a palliative approach is adopted. Taking care of the older adult takes certain expertise not only in the Comprehensive Geriatric Evaluation but also in also managing survivorship issues that arise well after treatment is completed.  

As a Resident in Internal Medicine I was fascinated by malignancy and the science behind Hematology/Oncology yet I was noted by my supervising physicians that I had also mastered the psychosocial aspects of medicine and was very involved in the care of older adults. I had often spent additional time with families and addressed caregiver issues. It was at this time I switched my focus onto the unique needs and challenges faced by older adults diagnosed with malignancy. Once I had connected with Geriatric Oncologists at Memorial Sloan Kettering Cancer Center where I arranged for an elective rotation as a Geriatric Fellow I simply knew that this was the field for me. I had also had the opportunity to meet and connect with many geriatric oncologists at meetings and this also fueled my interest in research as well. Currently I am exploring cognitive deficits and other functional deficits that arise from chemotherapy and more newer immunotherapy regimens.  I would like to be able to be an advocate for my patients and work alongside Oncologists in co managing older adults with cancer.

Public Health

It was said once that the purpose of public health is to promote social justice as aptly stated by former CDC Director and famed epidemiologist William Foege.  As a physician, I can see how medical treatments can greatly impact individual lives yet the psychosocial aspects that affect health cannot be ignored. These can be disparities based on race, socioeconomic factors or in some cases simply age. As I had trained in Internal Medicine I had taken care of people from all walks of life yet I was fascinated by the not only the complexity of taking care of older adults,

In addition, older adults depend greatly on public health policy which impacts their health as their vulnerability in many aspects require social support. Now while training in Geriatric Medicine I have seen for example how a disease like Alzheimer's not only affects the diagnosed but also their families.

Patients and their families more than the medication that I prescribe depend on social and governmental programs to help cope with the challenges that dementia poses. The topics that I covered while completing my MPH degree apply to how vulnerable and frail older adults can lead heathy and fulfilling lives.  What I have learned is that Geriatrics is nuanced and a “one size fits all” approach cannot be adopted. Therefore, in the area of disaster management and planning, a particular interest of mine, there needs to be a careful review of the current paradigm when it comes to vulnerable populations like the elderly. The lessons of Hurricanes Katrina, Sandy and now COVID-19 cannot be neglected any longer. The toll that COVID-19 has taken on America's nursing homes is staggering resulting in 40% of nations' total deaths as of this writing. While taking care of these patients, I had the opportunity to not only deal with the individual nursing home residents and their families but I also got a front row seat to the administrative aspect of managing Long Term Care. As I was observing practices there many times where my MPH coursework in Systems Improvement came to mind. It was during this time I was determined to take what I had learned and build on it by applying to the DrPH program at NYMC. Beyond simply becoming a Certified Medical Director of a long term care facility, my aim is to go beyond to help develop a framework which would include all stakeholders to address the lack of emergency preparedness. I plan to gain more experience in creating, analyzing and implementing management strategies that take into account budget constraints and staffing shortages which are prevalent in nursing homes. By working as, a physician, I have also become well acquainted with patients with cognitive impairment for whom most often medical/pharmacological interventions show little effectiveness. It is the improvements in the delivery of care and a team based approach which creates a culture that often make the difference.

Long Term Care facilities can be structured and designed in innovative ways that help these residents thrive. When it comes to emergency preparedness most often it is the most vulnerable such as those with cognitive impairment that suffer the most. My thesis will explore a more comprehensive approach to emergency preparedness to nursing homes/long term care while keeping in mind the principles I have learned in Geriatric Medicine.  I have a passion for public health as evidenced by my commitment to educating the public through the power of the mass media by spending a year working at Warner Media's CNN Medical Unit and now currently especially during the Coronavirus Pandemic as an active part of Walt Disney Television's ABC News Medical Unit.  I aim to use my skills as a physician now to go further as I have discussed when I was selected to interview with the CDC's Epidemiological Intelligence Service where at that time I knew well before the current pandemic that Long Term Care facilities are going to be most vulnerable in any infectious disease epidemic and it would take a combination of coordination and preparedness to rise to the challenge. I chose NYMC over all of the other potential programs that were out there because of amazing foundation I had received during my MPH coursework and I cannot think of a better program that would help to support my goals especially when it comes to emergency preparedness through the NYMC Center for Disaster Medicine. Furthermore, The Center for Long Term Care just makes NYMC the perfect opportunity for me to reach my goals. Overall, public health is indeed social justice and it begins with aligning policies and management with the goal of helping people most vulnerable to achieve true health and I am ready to answer that call.

Journalism

Ever since I can remember I have always been passionate about being able to impact public health by educating and empowering patients through the power of the media. Since my undergraduate years as a news anchor for my college radio station I realized the amazing reach and influence the mass media has on not only shaping societal perceptions but also it has the ability to initiate change. I had originally met with Dr. Timothy Johnson of ABC News when I was in High School and that is how I really understood how medicine and the media merge. Since then I have been working very hard whilst I pursing my career in medicine to better understand the industry. I had worked with mentors to improve my writing and communication skills. I was fortunate enough to work at CNN as part of their medical unit well before medical school but really wanted to learn more about how I can apply my knowledge as a physician when it comes to critically appraising research for patients. Now after completing my Internal Medicine residency I had gotten a real sense of what patients do with information that they hear or see in the mass media. Often during my residency I would have to keep a pulse on the medical research that was being reported on as my patients would often ask me questions on it. I take great pride in being able to explain complicated medical concepts to patients and families . Now as a Geriatrician, I see not only the multiple medical issues facing this population but also the psychosocial, societal and governmental influences on aging and disease. Policy and societal misconceptions about aging can effectively be addressed by better awareness and the power of the media plays an important role in this regard. I plan to use my background in broadcast medical journalism and perfect it so I can become an effective leader and advocate for the older adult. I plan to use this unique opportunity to go beyond clinical medicine as a modern physician needs to be well versed in the public health aspect of practice in order to be a leader.