Looking back, I made a detour in my career to become an internist-geriatrician. I have always liked working with elderly. For example, during high school I already had a summer job in an elderly home. Nonetheless my interest in working with the elderly patients came much later. After high school, I initially started studying in the field of Human Movement Sciences. I enjoyed classes in neurology and the musculoskeletal system. I found that I did not only want to know about these subjects but also treat patients, therefore I switched to studying medicine, after my master.
dr. M. Muller
I noticed that especially elderly people are not treated optimally. I see the older patient as a complicated puzzle. Other specialists are far more organ-based. This last approach is perfect for young patients with a single problem but does not suffice for older fragile patients with multiple problems. In geriatrics, we look at the whole patient and are interested in the interrelation between diseases, medication, and functional problems such as physical functioning and cognitive functioning. In deciding what the most suitable treatment is for the patients we use a patient-targeted approach by taking into account patient’s wishes, life expectancy and quality of life. Geriatrics is not protocol based which makes the treatment of patients very interesting. When I speak with patients about the consequences of their treatment options it often involves ethical dilemmas patients need to deal with. Do they wish treatment for cancer knowing that the side effects could make them sicker and that their quality of life during their remaining life-expectancy will dramatically decrease? Should we start a lipid lowering drug in a 90-year-old patient? Should we stop the anticoagulants in older patients with a very high risk of falling? These types of decisions require more than a 10-minute talk that doctors usually have. As an internist-geriatrician I have approximately 30-45 minutes consult time per patient, which makes it possible to really engage these patients.
The older population is very heterogeneous, ranging from extremely frail patients to very fit patients. This clinical variation within the population was a motivation for going into research. Most current medical guidelines are founded on research that has been performed in younger adults. In most studies, older patients are underrepresented and it is therefore unknown whether the current evidence of treatments can be translated to the treatment of frail older patients. I often ask myself whether or not I should treat this older patient according to the current guidelines or whether I should use an alternative treatment. Finding tailor-made treatments for older patients is what I like to do. My area of expertise is in the connection between the heart and the brain. Treatment for hypertension in frail older patients requires a different approach. A low blood pressure, for example, might cause less cerebral perfusion, causing neurologic problems. The fun thing about doing research is that once you start working on a problem, you always end up raising more questions than being able to answer.
I hope that my research contributes to the understanding of the interaction and relation between the fields of cardiac and neurovascular system. My ambition is to start an outpatient heart-brain clinic. A lot of people with cardiovascular comorbidities have brain damage with cognitive problems or mood disorders. I would like to contribute to the understanding of this problem and to find appropriate treatments.
My advice for young doctors is to take time and show interest in your older patients, as almost every future doctor will treat a lot of older patients. Ask your older patients what they expect from their remaining years and what they like and love in their life.
1991 Human Movement Sciences, Radboud University (MSc)
1994 Medicine, Radboud university (MD)
1999 AGNIO neurology
2000 Phd student, UMC, Utrecht (PhD)
2003 AIOS Clinical Geriatrics
2008 AIOS internist-geriatrician
2009 Internist-Geriatrician, VUmc
2011 Post doc National Institute on Aging, National Institutes of Health
2014 Internist-geriatrician LUMC
Current position (since 2016): Associate Professor Internal/Geriatric Medicine VUmc