DIMENSIONS Spring 1997


Following in her father's footsteps and responding to her own need to help people, Dr. Marie-Florence Shadlen became a physician. However, she says, it wasn't until she began working in the field of geriatrics that she realized just how well her chosen career suited her.

Shadlen, acting assistant professor of medicine, came to the University of Washington about a year and a half ago. She is an internist and geriatrician whose practice at the General Internal Medicine Center and Geriatric and Family Services Clinic at UWMC-Roosevelt includes both younger and older adults.

Born in Haiti, Shadlen emigrated to New York when she was 9. After completing her undergraduate education and medical school at Brown University, she did her residency in internal medicine at Kaiser Hospital in Oakland, Calif. She then returned to Brown University for a fellowship in geriatrics, followed by another fellowship in geriatrics at Stanford University.

Shadlen's first position after finishing her geriatrics training was as medical director of an Alzheimer's unit in a Veterans Affairs Medical Center in California. In this position she discovered the full meaning of providing care for demented older adults, an experience that was sometimes painful, yet truly enlightening. She also discovered how well she fit the role of advocate for people who were often too easily dismissed.

"There were a lot of debates on the appropriateness of treatment," she remembers. "Many times I had experiences such as trying to convince a surgeon to fix a fractured hip for someone who was no longer mentally competent but whose only pleasure in life was walking around in the garden. My background came into play because I realized that these institutionalized demented elders were as fragile and as vulnerable as the Haitians that I'd left behind. I think my sense of advocacy is probably derived from my own experience as kind of a survivor of a marginalized minority."

Now at the UW, in addition to working as a clinician implementing the lessons she has learned, Shadlen works as a faculty member teaching others. She is also a burgeoning researcher, continuing to learn herself.

In the clinical setting, along with being a member of the multidisciplinary team that evaluates patients for dementia, she supervises medical residents in their geriatrics training. "I feel that teaching geriatrics is one of the most gratifying and important things that I do," she says. "It's still a relatively young discipline and it's an under represented area of training, even though the median age in an internist's practice is about 60."

Becoming an interpreter and advocate for patients with Alzheimer's disease is an important part of what Shadlen shares with residents. "I've learned that people remain who they are even when they're severely diminished mentally. They're able to communicate, but they have different modes. A person with dementia might sound like they're speaking gibberish, but if you really listen there's a consistency in the content and there's a context to it."

Over the past six months Shadlen has begun looking at Alzheimer's disease from a research perspective. She has received a three-year UW Minority Faculty Development Award that is enabling her to develop new skills she will put to use investigating ethnic variations in Alzheimer's disease. "Currently, there's very little published data on clinical factors including caregiving issues that differ among ethnic groups," Shadlen points out. "There is also biological information to be gained from studies of Alzheimer's in different ethnicities because some early data show differences in genetic risk factors. We don't know whether these genetic risks are related to the actual incidence of the disease."

To gain more insight into the genetics piece, Shadlen has been studying work taking place in the lab of Dr. George Martin, director of the ADRC. "My apprenticeship in Dr. Martin's lab is helping me learn the language of genetics research so that I'll be able to educate my patients and colleagues about these issues," says Shadlen. "I think that there are ethical implications that apply to all populations as we learn more about genetic risk and disease. I think they will be particularly pertinent to certain ethnic groups who have not had as much interaction with the health care system."

Shadlen feels a synergism growing as she combines her clinical work with efforts to rigorously measure and learn from ethnic and cultural differences in coping with the stresses of Alzheimer's disease. "There's an aspect of teaching and research that has kind of a multiplier effect," she says. "I want to take part in that and still have the intimate interactions with patients that raise questions tor me and also feed me. I need to be of help."

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