Tales of Joy in Geriatrics

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A Golden Career in Geriatrics

As the longtime director of the Johns Hopkins Division of Geriatric Medicine and Gerontology, John Burton promoted the revival of the house call for homebound older patients, as well as a team-based approach to their care, which helped lead to programs like Johns Hopkins Home-Based Medicine (JHOME) and Hospital at Home. He promoted geriatric research and geriatric education across specialties, leading to the Orthopedic–Geriatric Medicine Hip Fracture Service. He was director of the Geriatric Education Center and Consortium, and developed the fellowship program in geriatrics. He won countless awards for his pioneering work, and the Johns Hopkins Health System renamed the Johns Hopkins Care Center the John R. Burton Pavilion in 2003.

During his “Tales of Joy” CIM Seminar, Burton talked about collaborating for 40 years with Johns Hopkins Bayview nurse Jane Marks, now associate director of the Johns Hopkins Geriatric Workforce Enhancement Program. Their demonstration project providing hospital-level care for patients at home — an initiative supported by the John A. Hartford Foundation — became, under the leadership  of geriatrician Bruce Leff, Hospital at Home, an innovation now used in 150 places around the country and in countries around the world. “It was a terrific partnership,” Burton said. “She certainly made me a much better physician.”

“When I think of the words ‘humanizing medicine,’ the image that immediately pops into my head is a picture of John Burton,” says CIM Director David Hellmann, describing the legendary clinician who helped establish and shape the practice of geriatric medicine, not only at Johns Hopkins but across the country.

Now a professor of medicine emeritus, Burton “has had an extraordinary impact on generations of physicians,” said Hellmann in introducing Burton before his recent CIM Seminar, “The Humanization of Medicine: Tales of Joy in Clinical Practice.”

“Caring for patients has been so incredibly rewarding,” said Burton, who for many years served as director of the Johns Hopkins Division of Geriatric Medicine and Gerontology, where he promoted the revival of the house call for homebound older patients (see sidebar box). “I loved every day of it, particularly geriatrics.” He went on to talk about the rich experience of letting patients and colleagues teach him.

The White Coat Story

Burton’s first tale of joy was what he calls “The White Coat Story,” when as a new intern he was told to “cover the geriatrics center…. I’d never heard the term ‘geriatrics,’” he said. But he dutifully reported to the center, albeit with purple dye on his coat because he’d just spilled it on himself doing a gram stain on a patient in the ER.

“So I went to the nurse, who was about my age, and said, ‘I’m Dr. Burton, and I’m here to help you with any problems.’ And she looked at me, frowned and said, ‘Young man, you are not seeing any of my patients. You are not seeing anybody looking like that.’” She told him the head of the institution, Mason Lord, not only always wore a clean, starched white coat, he wore it with a fresh carnation in the lapel “out of respect for the patients.”

“But then she smiled and said, ‘Sit down. You look awful. Let me get you a cup of tea and then we will see my patients together.’ That was my introduction to geriatrics and the humbling experience of how you present yourself to patients,” Burton said.

‘How I Learned to Grow Dahlias’

Burton received a call from a mentor, asking if he could help a vibrant, 88-year-old photographic artist who had given up hope. She had no family and lived alone, except for a caregiver, and she rarely left the hospital bed set up in her living room.

Burton started by making a house call, where he found “her home adorned with the majesty of the photographic artistry she had created” and her bed situated in front of a bay window with a curtain long closed. After the two chatted for a while, he told her he could see better to examine her if they opened the window shade. “Outside was a remarkable garden with a large plot of dahlias,” said Burton. “I told her, ‘I’ve tried to grow dahlias for years and I just can’t do it.’ She lit up. At each visit she taught him a little more about growing the spectacular flowers, saying, “I have a lesson for you.”

At her funeral, the mentor asked:
“‘John, what medicine did you find that gave her those extra four years?’ And we both cried as we talked about dahlias.”

“Caring for patients has been so incredibly rewarding. I loved every day of it, particularly geriatrics.” – John Burton

Learning from a Longtime Secretary of Defense

Former U.S. Secretary of Defense Clark Clifford had advised five U.S. presidents and, at 88, was eager to finish some important writing projects. But his doctors had confined him to his bed, largely due to severe inflammatory heart disease. Burton paid him a house call, and the two soon became “great friends.” Slowly, said Burton, “we were able to get him mobilized a little bit and back to where he could work on his books.”

Clifford even participated in a Grand Rounds presentation with Burton, given before 150 doctors, nurses and students in Carroll Auditorium at Bayview, on how best to treat a patient. “I said, Secretary Clifford, you’ve had a lot of complex experiences with the health care system in recent years. What advice would you give these people here?” recalled Burton. “He thought a minute, and he looked up like he was advising the president in a cabinet meeting.” Then Clifford shared these pearls: “Know your patient well. Ask the patient what they think, and then listen more than you talk. Explain clearly your thinking. Make house calls. Never take a phone call when you’re with a patient.”

“Patients,” said Burton in concluding his talk, “are our best teachers.”