I was looking for a life that would be both intellectually challenging and socially meaningful and I encountered an inspiring role model.

"Pursuing difficult questions — in science and in policy — takes one to interesting places," says Christine Cassel, M.D., a renowned expert in geriatric medicine and medical ethics. She works to improve quality of life for elderly patients, challenging out-of-date ideas about what can be expected in the aging process.

"A geriatrician," she explains "is like a pediatrician but at the other end of life. As it is true with children, older people have medical needs that are different from those of midlife adults... Our job is to improve the quality of life for the elderly and to keep them functional and independent for as long as possible. And when the end of life comes, our job is to keep them as dignified and comfortable as possible." Geriatrics has only been a formal specialty in American medicine since the 1980s, and although the United States is facing a demographic "bubble" of the aging population, geriatrics is still not one of the most popular specialties.

Born in Minneapolis, Minnesota, in 1945, Christine Karen Cassel first realized that care of the elderly could be a physician's primary concern while she was medical student at the University of Massachusetts. Though most students tended to focus on unique cases from a clinical perspective, she noticed that 90 percent of patients in the wards were elderly patients with problems common to them. Medical specialties tended to ignore syndromes of aging such as mental confusion, urinary incontinence, instability and gait disorders, failure to thrive, and depression. A geriatrician, however, seeks ways to improve those conditions and coordinate care. So if an older person is seeing several specialists who don't often talk to one another, the geriatrician would be the one to keep an eye on the total picture. "A big part of the work I do is to try to create a medical profession that is knowledgeable about the issues of older patients... Our system is not designed to take good care of people with chronic illnesses, many of whom happen to be old... It's taught me a lot about the plain old simple value of being involved with people. Regardless of one's age or disabilities, human interaction is one of the things that seems to really make a difference in the quality of life."

Dr. Cassel received her medical degree from the University of Massachusetts Medical School in 1976, and completed her residency in internal medicine at Children's Hospital and the University of California at San Francisco from 1976 to 1978, with subsequent fellowships in bioethics and geriatrics at San Francisco in 1979 and Veterans Administration Medical Center, Portland, Oregon, from 1979 to 1981.

From 1985 to 1995 at the University of Chicago, Pritzker School of Medicine, Dr. Cassel was chief of the Section of General Internal Medicine, professor of geriatrics and medicine, director of the Robert Wood Johnson Clinical Scholars Program, and director of the Center for Health Policy Research. She was then chair of the Department of Geriatrics and Adult Development, and professor of geriatrics and medicine at Mount Sinai School of Medicine in New York City from 1995 to 2002.

Dr. Cassel is currently dean of the School of Medicine and vice-president for medical affairs at Oregon Health and Science University in Portland, Oregon. Among her many professional associations, Dr. Cassel is currently chair of the board of trustees for the American Board of Internal Medicine, chair of the board of the Greenwall Foundation, which supports work in bioethics, president of the American Federation for Aging Research, member of the Advisory Committee to the Director at the National Institutes of Health, and co-chair for the Committee on Assuring the Health of the Public in the 21st Century at the Institute of Medicine (IOM). Dr. Cassel served on previous IOM committees responsible for influential reports on quality of care and medical errors, and chaired a recent report on end-of-life care. She also served on the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry from 1997 to 1998.

An active scholar and lecturer, Dr. Cassel publishes extensively in professional journals, books, editorials and special reports. She is currently concerned with quality improvement in health care, health-professional education, biomedical ethics, geriatric medicine, palliative care, healthcare policy, and healthy aging. Nationally prominent as chief editor of a seminal textbook, Geriatric Medicine, soon to appear in its fourth edition, Dr. Cassel also edited A Practical Guide to Aging in 1997. Her book Older Americans and the Future of Medicare was in press as of Spring 2003. Dr. Cassel is on the editorial boards of several medical journals, including Archives of Internal Medicine, American Journal of Medicine, and Geriatrics.

What was my biggest obstacle?

Returning to school for pre-med training and paying for medical school. My undergraduate work was in philosophy — took some explaining to admissions committees in 1972.

How do I make a difference?

I make a difference through my work in 1) Patient Care; 2) Education; 3) Policy work

Who was my mentor?

I did not have single mentor. I give credit to many, including Paul Beeson, Alvin Tarlov, and Ruth Purtilo.

How has my career evolved over time?

Pursuing difficult questions — in science and in policy — takes one to interesting places.