Marcia Mecca, MD, Assistant Professor of Medicine (Geriatrics)

As part of our “Meet Yale Internal Medicine” series, today’s featured faculty is Marcia Mecca, MD, assistant professor of medicine (geriatrics).

For Marcia Mecca, MD, revolutionizing geriatric care means getting to the heart of one of its systemic issues: access.

“We never train enough geriatricians every year to make sure that every person over 65 has one,” said Mecca, assistant professor of medicine (geriatrics); and co-vice-chief for diversity, equity and inclusion (geriatrics). “What is essential is to help provide training for interns who will be involved in the care of the elderly, no matter what field they are heading into. So this is my passion: to educate and help instill important principles about the care of elderly patients in trainees, regardless of specialty choice.

Watching his grandparents navigate geriatric care has sparked Mecca’s interest in the specialty and continues to influence his work. “My grandmother once told me that she didn’t take her meds on Sundays because she wanted to go to church and her meds didn’t make her feel good,” Mecca said. “This was before I knew what polypharmacy was. I just thought, ‘There is something wrong here. Medicine should help you function. You shouldn’t have such side effects that you have to skip pills on the days you need them to get things done. ‘”

Today, Mecca runs the IMPROVE Polypharmacy Clinic as part of the Veterans Affairs (VA) Connecticut Health System Education Center for Interprofessional Primary Care. “We have tended to focus on older patients who are taking 10 or more drugs,” Mecca said. “On an educational level, the goal is to help the residents who take care of patients in this clinic to understand what polypharmacy is, its impact on patients, what are the different contributors to the problem and what we can do. do to improve it. Residents’ participation in this clinic helps them acquire the skills to care for complex elderly people in primary care.

Mecca says the feedback from residents at this clinic has been positive. “They said they are seeing changes in the care they are able to provide to elderly patients outside of the IMPROVE clinic,” Mecca said. “So it’s really exciting for me that the interns feel that the educational interventions we are working on are having an impact. “

For the future, Mecca wants to examine how to better treat elderly patients with pain. “We know that pain is something that can really impact a person’s quality of life,” Mecca said.

“But the drugs we have available still have many side effects in older people, which makes pain management more complex. It is interesting to think about how best to approach this and to teach trainees so that they feel ready to deal with complex patients who may have substance abuse issues, substance abuse issues, cognitive issues or whatever. who is before. We have studied polypharmacy more broadly, but examining this particular area, polypharmacy and patients with chronic pain, is an area of ​​future work.

Mecca also worked with a nationwide network of colleagues to explore how best to implement and teach priority patient care. “Dr. [Mary] Tinetti, initiated this effort and it is exciting to see it expand and consider the best pedagogical approaches for different learners and contexts, ”said Mecca. “The goal is to help seniors identify their health care priorities, and then ensure that the care plans we recommend for patients align with those priorities and goals. Mecca says priority patient care is an effective tool that helps patients and clinicians achieve what matters most to patients. “This is a change in the approach to patient care, especially for older people with multiple chronic conditions. It takes time to master, but it’s so rewarding to experience this “aha” moment with the learners. “

Mecca was also recently appointed Co-Vice-Chief for Diversity, Equity and Inclusion of the Section of Geriatrics. “I am looking forward to further work, in collaboration with Dr. [Inginia] Genao and the other vice-chiefs of other sections of the department, ”Mecca said. “We strive to create a diverse and equitable learning environment where everyone feels included and supported to succeed in doing the work they love. “

Yale’s Geriatrics Section strives to improve the health of older adults by providing exceptional patient care, training future leaders and innovators in aging, and engaging in cutting-edge research. To learn more about their mission, visit Geriatrics.

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