An Interview with John Burton
John Burton, one of the founding fathers of modern geriatrics, first served as the director of the Division of Geriatric Medicine at the Johns Hopkins Bayview Medical Center more than 20 years ago. Now, he is director of the John Hopkins Geriatric Education Center, located in a pavilion that bears his name. Search went one-on-one with Burton and found out why he’s still so excited about this medical discipline.
How did you develop an interest in geriatrics?
I was trained as a nephrologist, but I wanted to be on the front lines as a primary care physician. In 1975, I became medical director of the Southeast Community Health Corporation, a community-based primary care practice. I quickly discovered a liking for treating older people. In addition, because older patients have complicated, multiple illnesses and often have minimal psychological reserves, it puts a premium on diagnostic and therapeutic judgment. You just can’t look in a textbook to find all the answers. Most of all, I learned that, in geriatrics, you need to be an effective communicator, possess deep compassion and exercise outstanding judgment. Serving as a primary care physician for older patients was the most challenging and rewarding experience I’ve ever had in medicine.
Did you make house calls?
Yes. We instituted a house call program in the late 1970s that allowed us to support homebound seniors. We moved our community-based practice to Hopkins in 1982 and developed a day care program there as well. Then we set about the business of building a series of clinical programs that could, in a comprehensive continuum of care, serve the specific needs of the elderly. The real Hopkins pioneer and visionary in this area was Mason Lord. One of my great regrets is that I never got to meet him. He died of a brain tumor at age 39.
What makes geriatric medicine at Hopkins so exciting?
Hopkins is an extraordinarily exciting place to practice medicine. Having direct access to world-class specialists, to be able to bounce ideas off experts about the best treatment for geriatric patients is something you won’t find at every academic medical center.
What are the major hurdles in practicing geriatrics?
For one thing, it is challenging from a financial point of view. Since it’s predominately primary care, geriatrics can be very labor-intensive. Yet, Medicare limits your reimbursement. A geriatrician often is dependent on developing partnerships with the medical school and hospital leaders to create and manage innovative care programs. I’ve been fortunate to enjoy the strong support of these leaders.
What projects are you working on now?
We are completing our study of the National Home Hospital initiative, which involves taking care of acutely ill geriatric patients in a home setting, rather than in the hospital, and we’ll be publishing the results soon.
Hopkins Search
Spring 2004
Volume 2, Number 2
