Taking Care Of Our Kupuna
Interviewed by Rasa Fournier
Wednesday - October 20, 2010
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Dr. Warren Wong
Geriatrician at Hawaii Permanente Medical Group, Kaiser Permanente
Where did you receive your schooling/training?
I went to medical school at the University of California at Davis, and received my initial internal medicine training at the University of California, San Francisco. I worked as a practicing internist with Kaiser Permanente on Maui and always had an interest in working with our older patients, so I decided to pursue a fellowship in geriatrics at the University of Hawaii. Most people don’t know that the University of Hawaii has one of the largest geriatric fellowship programs in the country, and I was one of the original fellows in that program.
How long have you been practicing?
More than 25 years.
Can you talk about your practice?
Geriatrics has gained popularity in the last 20 years. Many people still don’t really know what geriatrics is, but our population is aging rapidly and there’s a different twist to taking care of the elderly, especially as they become frail. Older people tend to worry a lot about losing their memory. That’s an area of specialty for geriatrics. Geriatricians are trained to know quite a bit about memory problems, and we have a different perspective on it than a psychiatrist or a neurologist. When people have memory problems, there’s often a lot more to it than just treating the disease. It’s also about making sure that the patient’s support system is adequate, and ensuring that patients are able to take care of themselves or are able to get help. I like to think of geriatrics as a little bit about understanding the disease, and a whole lot about understanding the social aspects - what support systems are available to our elderly patients - and the psychiatry (the experience of aging) behind aging.
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What percentage of elderly patients has memory problems?
About 5 percent have memory problems. Of course, it becomes more prevalent as people get older. When you get into your 80s, it’s a much higher percentage. In geriatrics, we see senior citizens in their 80s all the way through 100 years old.
How old was your oldest patient?
I’ve cared for patients as old as 104.
Besides memory loss, what areas do you specialize in?
Geriatrics is not just about managing disease. We put a lot of emphasis on a person’s quality of life, not just the quantity of life.
That may have very different meanings. It might mean taking away medicine rather than adding medicine. It may mean trying to figure out how we can simplify the medication regimen so that a person can continue to live independently. It’s about what makes a difference in a person’s life to maintain high quality and assure grace and dignity as a person ages.
When you mention quality vs. quantity, are you talking about comfort vs. “futile care”?
Our emphasis is always to make a difference in terms of quality of life, and maintaining a person’s grace and dignity play a major role in that.
Sometimes we increase the quantity of life by simplifying medications. There’s a certain point when worrying about someone’s cholesterol is probably not the most important thing to do if a person is reaching the last chapter of life. A lot of our patients ask us, “Can you make sure that we’re taking the medicines that are safe for us, and also only the medicines that are necessary to maintain our quality of life at this point?” We’ll spend time with our patients helping them to figure out which medications they sould be taking, and try to simplify things for them. Our mission is to provide the “right care, at the right time, in the right place.”
Is there anything new in the field?
We have a very active home visit program for people when it’s difficult to come in and see the doctor. There’s always one of us in our department who does home visits every day of the week. We do chronic home visits for people who are permanently homebound, and also provide care for people who are temporarily disabled because they’ve just been in the hospital.
What’s the most challenging part of your job?
It’s sometimes challenging to get families to work together with our patients. During difficult times, you want to see the family pull together, not fall apart. That’s part of the work we do - that’s grace and dignity. It’s not just about saying, “Here’s this pill to make your family work together better.” It’s about saying, “Let’s talk about things, let’s try to give you a professional opinion about what’s going on here, and let’s see what people think.” It’s always about getting to the whole story and, as the story evolves, the physician gets a better understanding of what’s going on. It’s what we call “the last chapter” - we always want to make that a good chapter, no matter what else happened in the rest of the book. Whether that last chapter is long or short, we always say, let’s do our best to make it good.
What’s the most rewarding part of your job?
The aspect that is most challenging also is what’s most rewarding: when we can make a big difference in a person’s life, when it’s more than just about pills. When people are at the most vulnerable stage in their lives, it’s rewarding when we can make them feel good about themselves, keep them from feeling isolated and assure them that we’re here to care for them. That’s the most rewarding part of my job. Home visits are a way of saying, “We understand your situation and we’re glad to help.” Kaiser Permanente really supports us in our work. The organization is seeing how rapidly our population is aging, and that this approach to taking care of the elderly is a really important aspect of caring for our community.
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