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Katie Salwei (Host): Thank you for tuning in to the Well Within Reach podcast. I'm your host, Katie Salwei, and joining me today is advanced practice provider Madhu Sharma with Riverside Medical Group. Thank you for joining me today Madhu. Could you please tell our audience a little bit about yourself? Where you're from? How you got into medicine?

Madhu Sharma, ANP-BC, MPH (Guest):   Sure. Well thank you Katie for having me here today and giving me this wonderful opportunity to speak about something that I've been actively involved with. Especially in Kankakee County for the past 11 years. Yes, I got involved into medicine because I've always loved the concept of helping people. I come from a family with strong medical backgrounds. It was just something that I just automatically fell into.

Host:   Okay. Great. Well, it is great to have you. So we’re going to talk about geriatrics today. So geriatrics is kind of one of those terms I don’t think a lot of people know about, and I think it would be great to hear more about it. Especially from somebody who works right within this field and internal medicine in general.

Madhu:   Yeah. Well, thank you so much. So geriatric medicine, or what we call geriatricians, this is something that there’re not enough of in this country. We have about 300 in Illinois and we need about 700 more. It evolves from taking care of the elderly patient. Now, back in the day people used to see geriatricians if they were over age 65, but now because of more public awareness, more education, more diagnostic imaging, we have considered that we can now see patients over the age of 50 as well. It depends on each patient’s independent functioning, their ability to do as much of what they can in life independently.

Host:   Okay. So yeah, there's kind of a different scope that you think about it. So how does a geriatrician differ from a primary care physician?

Madhu:   Right. Geriatricians are board certified in internal medicine and they can be family physicians as well, but they have about an extra two years of further training and then they become board certified in geriatric medicine.

Host:   Okay. So how exactly did you get into geriatric medicine? You come from a family of physicians in the medical field. So how did you choose this specific specialty?

Madhu:   Well, I had aging parents and I loved the way that they were treated by their geriatric doctor, and the kind of special focus that they have. They spend a little bit more time with the patients. I said, well, if I ever get an opportunity to take care of patients I will do the same as I would expect that my parents would have had. It’s become an excellent rewarding profession for me. Like I've said, I've been here now 11 years. There are two board certified physicians in this county. Currently Dr. Stephen Hermes who I had the opportunity to work with. He’s retired now. So now I'm working with Dr. Suleiman at Riverside Hospital.

Host:   Okay. Well it’s great to have you and I'm sure that your patients truly appreciate the time that you spend with them and the value that you put on the care you give them. So let’s learn a little bit more. So why would one need a geriatrician?

Madhu:   There’s going to be about 31 million people over the age of 75. The most rapid growing population is the one over age 85. So people are living longer. Because of this, they are needing more medical care. So we focus on those kind of things that are much more common amongst the elderly. We see the entire gambit of the population. We see them in the outpatient setting. Should they be hospitalized, we see them in the hospital. We even have a geriatric psychiatry floor in the hospital. Then should they have a step-down unit, then we send them for rehab purposes as well. We have nursing homes that we do rounds on. We even have memory care units in Kankakee County. Should they need hospice or palliative care, we’re also there for those patients as well.

Host:   Okay. So when you say we need 700 or we need more geriatricians in the area, I can definitely see why—or in the state. Because you guys are busy. You're all over the place. You're seeing patients not just in that primary care setting, which a lot of people kind of think, “Oh, I'm just going to go see my doctor here.” You guys go all over. So definitely a need for that. So what questions once they get to getting into an appointment with you, what kind of questions should your patients be asking you?

Madhu:   Well, generally they want to know how they're going to be taken care of, who’s going to be taking care of them should they be hospitalized. We like to make sure that they do have their things that are important for them to be at least thinking about that they’ve never thought about—You know, advanced medical living wills and the power of attorneys as well. Then we also see, okay, are they independent enough to live on their own and manage on their own in their homes? Do they need assistance? Do they need home health services? Are they able to take their medicines on their own? Are they able to eat proper healthy meals on their own? Then we take it forward from there. Every person, like I said, has individual different needs and we try to focus on everyone on an independent individual basis.

Host:   Okay. Well, that’s definitely a lot of things to think about, but it’s great to have providers that are asking those questions because I'm sure a lot of people don’t think about those things. Oh, am I remembering to take my medication or things like that. So it’s very important that you guys are doing that and a great piece of why a geriatrician is important to patients.

Madhu:   Right. We focus too also like there are the so-called geriatric giants in terms of major categories of impairment. Number one, immobility. Are they at a high risk for falls? What happens to them if they fall? Do they have help at home? How do they find help? Instability, incontinence is another thing. Then impaired intellectual capabilities. If they see a decline or if the family probably notices it a little bit more that they're not as sharp as they used to be. So that’s when a lot of them come and say, “Well, you know my mother’s been having some memory problems or she’s been acting differently, or she tends to see people in her room when they're not actually there.” So then they become concerned and they bring us their loved ones.

Host:   Okay. A few other questions they might come to you asking. Who will take care of them if their geriatrician or specialist isn’t available? Do you have others on call? How does that work in your office?

Madhu:   Yes, well we have 24 hour on call. So there will always be someone there to address their needs. Of course, you know, like I said Dr. Suleiman who is the geriatrician that I'm working with, he is on call. He does round on our patients in the hospital.

Host:   Okay. So that’s really a great asset to your team to be able to have that availability as well because you never know when something might happen, and you need to get ahold of that doctor. If they do have questions, should they be calling the office or are there other ways that they can message you as their provider?

Madhu:    Exactly. We are always there available. I especially. I mean I try to get them in if Dr. Suleiman is booked for the day, I definitely try to see them if not today the next day. You can always access questions or any kind of concerns you may be having through MyChart.

Host:   Okay. Yeah, that’s definitely a good piece. We also have a proxy piece available. So those kids caring for their older or their elderly parents can also be a proxy for that, and they can message you that way too. So that’s a good feature to have and that accessibility to you.

Madhu:   Exactly. No, we’re always accessible.

Host:   Well, that’s great. So in order for somebody to schedule an appointment with you, can they schedule online? Do they call your office?

Madhu:   Until now basically they’ve been calling the office and we haven’t had any problems scheduling them in as soon as possible. Like I said, Dr. Suleiman, he is the geriatrician. If they can't see him, then I can see them and then we are always in constant conversation with each other, Dr. Suleiman and I. There's no problem as far as getting them into the office for an appointment.

Host:   If you do want to schedule an appointment with Madhu or Dr. Suleiman, just if you call their office you can get ahold of them at 815-928-5090.

Madhu:   Exactly.

Host:   So that is available for you if you want to get that appointment. Is there anything else that we missed, or you want our audience to know Madhu?

Madhu:   Well there's the things that make us a little bit different from the other practices that we focus on. What are the things that are most important that we have to look for amongst the elderly? There's a big problem of polypharmacy. They are on so many medications. They go to this specialist; they get added one pill. They go to another specialist; they're added another medication. So by the time they come to us, I see so many that have 16/17 medications and they don’t even know what half of them are for. So we try to weed them out because as they get older, there's so many more side effects that they're susceptible to. So we try to weed out the ones that are not good for them as they get elderly, especially things that are sedatives. They're on Ativan, they're on Ambien, Benadryl. We try to make sure that if possible we can get them off them as soon as possible because they do have a lot of side effects.

Then we try to focus on a lot of the things that the younger people may not have because a lot of the times they come in with very vague symptoms. “Oh doc, I just don’t feel well.” They can't explain what is it that’s happening to them or they are confused, or they're dehydrated, or they have altered mental status. They have difficulty focusing on things. They say, “Well, you know, I just can't remember things that happened to me yesterday but yet I can remember things that happened to me 40 years ago.” So this is the kind of things that we look at. We look at their polypharmacy issue. This is one thing that we stress all the time is every appointment that you come to see us, bring your bag of medications. We go over them one by one and then we spend time explaining to them what every medication is for. I make it a point to label on their pill bottles what this is for. Then a lot of them are very lonely. They have decreased hearing; they can't drive anymore. They become totally inactive and they become lonely. So then you have problems with depression. So we look at that. So we look at what kind of a support system that person has. What are their nutritional habits? Are they eating healthy? Are they drinking enough? Some of them they don’t even realize when they had their last meal.

Then, of course, a lot of them have that concern of are they able to afford their medications? They're on a lot of expensive medications. Sometimes because they don’t have the money then they stop taking them. Then come all the medical problems that ensue. So we want to make sure that they're being compliant with their medications. If they're not able to afford it, we try to make sure that they have their medications one way or the other. Like I said, a lot of side effects of all the medications they're on. We want to make sure that they should not be sitting on the floor after having a fall for two or three hours. So we always say make sure if you're living alone, do you have a lifeline around your neck so that at least you can press a button and get help if you’re living alone. Or do you have neighbors that are there to support you? So we look at all these small little things that when you're younger, you don’t even have to pay attention to.

Host:   Well they could be small to the younger people, but they could be big things.

Madhu:   Exactly.

Host:   So those are all very important things and it’s great to have providers that are really looking into that and looking out for other patients and stuff like that. So, again, if you are looking for a provider, go ahead and call Madhu’s office. Her number is 815-928-5090. Thank you so much for sharing with us today Madhu. We appreciate having you on the show.

Madhu:   Well, thank you for giving me this opportunity to talk about something that I'm very, very passionate about because I think that growing older doesn’t mean that you have to lose your dignity. We want to provide the best care and try to make them function as well as they possibly can in their situation.

Host:   That’s important.

Madhu:   That’s important to me.

Host:   Very important. Well, very good, very good. Thank you for tuning in to the Well Within Reach podcast with advanced practice provide Madhu Sharma and your host Katie Salwei.