A Holistic Approach to Geriatric Care
By Barbara Spector
Marie Antonia Bernard '72
During her first years as a faculty member at Temple University's Division of General Internal Medicine in Philadelphia, Marie Antonia Bernard '72 found the greatest fulfillment in taking care of older patients. "They were a lot more interesting to me, both as people and in terms of their diseases," she says. While her care of younger patients involved treatments for relatively straightforward conditions, the elderly presented with problems such as falls and incontinence that she found intellectually challenging because the underlying causes were not always clear. "Their problems don't fall neatly into diagnoses," she explains.
She trained at the Geriatric Education Center of Pennsylvania and found that "my training helped me realize that taking care of older patients was even more complicated than I had thought." For example, the most effective treatments involve collaborations among nurses, social workers, physical therapists, psychologists, dietitians, pharmacists and/or chaplains as well as physicians, Bernard explains. "A holistic approach to care of the older individual brings about a better outcome," she says.
Today, as the founding chairperson of the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma College of Medicine, Oklahoma City, Bernard oversees multidisciplinary care of the elderly in a variety of settings. The department, the third of its kind established in the United States, conducts outpatient-clinic activities in conjunction with the university and the Oklahoma City Veterans Administration Hospital; runs a home-care program for frail veterans; offers consultative care; and has affiliations with nursing homes, says Bernard, an Oklahoma native who returned to her home state in 1990.
Another challenge, she notes, involves obtaining access to Medicare and other financial resources. In Oklahoma, where a substantial portion of the population consists of farmers and Native Americans, "many people don't have Medicaid because they don't want to apply for it, and they don't have Medicare because they didn't contribute enough to the Social Security system." In such cases, Bernard says, she and her staff do the best they can to cover the cost. "We're obligated to provide indigent care," she says.
Change in Plans
Among many honors, Bernard has been named several times as one of the "Best Doctors in America," a peer-reviewed distinction. She is chair of the Gerontological Society of America's Clinical Medicine Section and serves on the National Institute of Aging's Minority Task Force and the National Institutes of Health's National Advisory Council on Aging. She also chairs the Department of Veterans Affairs' National Research Advisory Council.
Yet when she entered Bryn Mawr College, Bernard intended to avoid a career in medicine because she thought her parents, both physicians, worked too hard. She planned instead to major in French and become a United Nations interpreter. But she found that "my French with an Oklahoma accent didn't cut it" and that she was falling behind her classmates, many of whom had visited France several times.
Bernard next planned to major in English but changed her mind when she discovered she was doing well in her chemistry class. "Science was presented in such a clear fashion at Bryn Mawr," she says. "I really appreciated the focus on the student."
Bernard applied to Bryn Mawr via early decision (although she had not visited the campus) thanks to the influence of "a very smart mother" who suggested she attend school away from home to broaden her experience, preferably at a Seven Sisters school in a region where relatives lived. Bryn Mawr fit the bill. "It was a wonderful, supportive and nurturing environment for a shy little girl from Oklahoma," she says.
Bernard went on to receive her M.D. degree from the University of Pennsylvania in 1976 and did her residency at Temple University Hospital. As a Temple faculty member, Bernard studied protein calorie malnutrition and was co-director of the nutrition support team, focusing on the technical difficulties of inserting feeding tubes. When she arrived at Oklahoma, "I refocused that research to study what happens prior to the person becoming so malnourished that they need that type of intervention."
Building a Department
In recent years, Bernard has directed much of her energy toward building the department she helped found. She started in 1997 with two physicians and one Ph.D. and now oversees 14 physicians and five Ph.D.'s. She also has established a clinical geriatrics rotation for third-year medical students that began in 2003-04.
Bernard has been incorporating mentoring into medical student education and is conducting a longitudinal study of the effect of mentoring by senior citizens on medical students' attitudes toward aging.
Bernard says the mentoring she received throughout her career has helped her, though she may not have realized it at the time. While mentoring is important for all physicians, it is especially important for minorities because there are few of them in top academic positions, she says. "I didn't recognize the importance, but people stepped in to give me advice," she says.
Yet she hopes her protégés stop to consider whether the advice they receive will help in their individual situations. "The big issue is balance" between personal and institutional priorities, she says. "If one has a clear idea of what one wants to achieve, it's easier to keep that balance."
Barbara Spector writes on science and technology as well as business topics. She is the editor-in-chief of Family Business magazine and former editor of The Scientist.