A 'House' moment

On a recent day of rounds at Springtree, Camardi walked briskly with his entourage of students: two family practice doctors — fellows in Carilion’s geriatric fellowship program — one med-school student and two internal medicine residents.

John Zehmer (right) watches as his wife, Dorothy, cries while talking to Dr. Michael Camardi.

His questions were tough. Camardi had a signature “take-home message” to be gained from each patient they visited, and the young doctors were prodded to think holistically about each patient’s care — observing and talking to them and, above all, making physical contact.

After an extended visit with nursing-home resident Ruth Kelley, she read the group a humorous essay on aging, which sent Camardi into one of his typical, gut-clenching guffaws.

“He wants you to be personal with the patient and know everything about them — their family dynamics, if the patient is sad, even if the patient doesn’t like a certain food,” geriatrics fellow Cristian Falcon said.

“He is this way all the time, and sometimes we go nuts.”

Outside Kelley’s room, Camardi peppered the students with questions: How did she seem compared to four months ago, when she was demented and confused?

Much improved.

Did the risk factors associated with her previously prescribed blood thinner justify the use of it?

Not on your life.

What effect did Camardi’s discovery of her thyroid deficiency have on her dementia?

Huge.

Whereas doctors before him had assumed that Kelley was simply tired — after all, when you’re old, isn’t it normal to be really tired? — Camardi suspected something else was amiss and had her thyroid tested.

“It was like turning a light on and off with her,” Falcon said.

“Before, she was on too many meds. But they weren’t the right meds.”

At which point Falcon pulled a pretend bouquet of flowers from his sleeve.

“You see, he is like a magician,” Falcon said, grinning.

Like many of Camardi’s young charges, Falcon will go on to practice geriatrics and, more importantly, he’ll teach medical residents how to do it, too.

Camardi doesn’t envision the government addressing the shortage in geriatrics-trained doctors any time soon. With his workload increasing by the week, he calls the shortage the “Armageddon of geriatrics.”

In July, the government will institute steeper cuts in Medicare physician payments — at a time when many doctors have already closed their practices to new Medicare patients. Doctors at the Center for Healthy Aging put the number of Roanoke-area doctors in that camp at more than half.

“I can’t control what the government does, but I can control what I teach and how I do it,” Camardi said. “So hopefully I am motivating my students and showing them how rewarding this field can be.”

When he dies, he hopes his wife has this saying engraved on his headstone: “He taught doctors how to treat old folks better.”