Biography: Dr. Christine Karen Cassel
Year: 1995
Achievement: Dr. Christine Cassel was the first woman chair of the American Board of Internal Medicine.
Year: 1996
Achievement: Dr. Christine Cassel was the first woman president of the American College of Physicians.
Year: 2002
Achievement: Dr. Christine Cassel was the first woman dean of Oregon Health & Science University, Portland, Oregon.
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, medical ethics and quality of care. "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 became the first female dean of the School of Medicine and served as vice-president for medical affairs at Oregon Health and Science University in Portland, Oregon in 2002. Currently, she is President and CEO of the American Board of Internal Medicine and the ABIM Foundation.
Among her many professional associations, Dr. Cassel currently sits on the board of directors of the Greenwall Foundation, Kaiser Permanente, Premier Inc and other organizations with quality health care agendas. She is a representative to the National Quality Forum's National Priorities Partnership, a member of the Commonwealth Fund's Commission on a High Performance Health System and the Institute of Medicine Governing Council. Dr. Cassel was president of the American Federation for Aging Research, and has served on Institute of Medicine 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, now in its fourth edition, Dr. Cassel also edited A Practical Guide to Aging in 1997. Dr. Cassel served on the editorial boards of several medical journals, including Archives of Internal Medicine, American Journal of Medicine and Geriatrics. Her most recent book is Medicare Matters: What Geriatric Medicine Can Teach American Health Care.
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.
Dr. Christine Karen Cassel
Dr. Christine Karen Cassel
When I first began in this field, the standard rounds we would make in the hospital: we would come in, talk with the patient, listen to their heart and their lungs, maybe feel the abdomen. If the patient was in a wet bed it wasn't our problem, it was a nursing problem. You would leave the room never knowing whether the patient was able to walk or not.
And if the patient was confused, all too often you said, 'Well, that's sundowning, that happens with older people.' So the whole range of functional issues that really make a difference between whether an elder person can live alone, or has to be in a nursing home, were things that we didn't have a clue about how to address. Urinary incontinence, mental confusion, and walking or ambulation, and the strength of somebody's ability to get themselves to the bathroom, or even out of bed.
And maybe I'm just a sensible woman or something, but it just seemed to me there needed to be a lot more attention on these common problems of older people, which we weren't learning enough about. And so the idea of having a field of geriatric medicine where I could do that, that would be morally needed and make a contribution to people who needed help. At the same time that it would be full of important ethical issues that needed study and analysis, and that were philosophically challenging. The reason why intergenerational connection is so important is to give real meaning and vitality to our aging society. Because we're moving from a society where a hundred years ago 5 percent of the population was over 65, to 20 years from now 20 percent of the population will be over 65. That means one out of five people, everywhere you go-in the movie theaters, in the grocery stores, in the airports, on the golf courses-wherever you are, are going to be 'senior citizens.' To marginalize and make irrelevant one-fifth of the population is just not a smart thing for our society to do. Plus, people are healthier and more independent as they age these days, and that's going to continue, too. So we can't afford as a society not to take advantage of the skills and contribution of that whole segment of our population. So it's very important to me that we find ways that younger people can interact with older people, to counteract stereotypes, ageism, negative attitudes about their own aging, and to help reinforce the connections within their own families.
Many of my colleagues in medicine say to me, 'How can you do this. It's so depressing, and it's so frustrating, because nobody ever gets better.' Well, if you look at most of medicine, there are very few dramatic cures anymore. What we've done is we've managed to make people able to live better with chronic illness-with heart disease, even with cancer. And geriatrics is just like that.
When you help somebody live better, with multiple medical problems, or even help them die better, at the end of their life, their family and that patient are hugely grateful. And I find it very rewarding and so I tell people "what do you mean?" I think this is actually a very rewarding and satisfying field.