Editorial
Front Page - Friday, February 12, 2010
Primary care physician making things easy for patients
David Laprad
Dr. Monica Gefter has a gift for making things that might be difficult for lay people to understand easy to grasp. When asked to explain what she means when she says she practices internal medicine, for example, she says she’s a pediatrician for adults. “We take care of every issue an adult might have,” she says, her voice gentle, like that of a soft-spoken kindergarten teacher. “You might come to us about your blood pressure, your cholesterol, your diabetes or your aches and pains.”
When Gefter says “we,” she’s talking about herself and the five doctors with whom she formed Academic Internal Medicine, a primary care practice at Erlanger open since last September. She and her colleagues saw Chattanooga’s primary care community migrating to the Hamilton Place and Gunbarrell Road area and decided to launch a new practice downtown. “It’s not easy to get in to see a primary care physician right now. Most internists (doctors who practice internal medicine) are booked for months,” she says. “We wanted to make sure Erlanger’s employees and the other people who work downtown had a place to go.”
Gefter and her fellow physicians also wanted to provide a good role model for the internal medicine residents at Erlanger. “Everyone wants to specialize, so the medical profession is having trouble keeping doctors in primary care,” she says. “We wanted the residents to see they can provide excellent primary care, develop good relationships with their patients and have a satisfying practice.”
Internal medicine is just one of Gefter’s passions. Another is preventive medicine. “We can prevent so much of what we see. For example, a lot of people are in the pre-diabetic stage but don’t know it,” she says. “If we can get to them before the disease sets in, we can stop its progression.”
Helping people avoid the consequences of today’s prevalent diseases motivates Gefter daily. She’s especially passionate about preventing osteoporosis, something many in the medical establishment once considered inevitable and untreatable. “We can prevent that! We don’t have to have people shrinking and bending over as they grow older. That’s exciting,” she says.
Gefter says many people could avoid heart disease, too, by having their doctor look at their family history and other risk factors and suggesting modifications to their lifestyle. As good as this information is, though, getting people to take action is one of her biggest challenges.
“I’d love to get people excited about their health before they get sick,” she says. “But most people say they don’t have time to take care of themselves. Everyone is afraid of losing their job, or has had to take over what someone else at work was doing, so it’s become difficult to focus on ourselves and what we can do to stay healthy.”
To help, Gefter offers a few tips ranging from light exercise to eating right. She’s big on pedometers, for instance, as they’re a simple way to encourage someone to be more active. “Your goal should be 10,000 steps, so if you put one on, and at the end of the day, you’ve only gone 4,000 steps, then you know to step it up,” she says.
Gefter says everyone should know their blood pressure and cholesterol levels, too, as those numbers can represent serious consequences down the road. “If I’m taking care of someone with high blood pressure, I’m going to make sure they understand why they need to get it under control,” she says.
Her desire to help her patients understand their health better, especially when it comes to explaining the terrible cost of today’s diseases and how to avoid them, has helped Gefter to develop a knack for clarity. One of the ways in which her talent manifests itself is through drawings she makes on a small yellow pad she keeps in the front pocket of her doctor’s coat. As she leafs through it, she stops at a crude drawing she made of receptors in the brain as part of her effort to help a patient understand depression.
“My patients are always telling me they’ve never had anyone explain these things to them in such detail,” Gefter says. “But being a doctor is like being a teacher. I have to make sure my patient understands where we’re going and why we’re going there. I also want them to know we’re going there together.”
Gefter says some people resist making big changes, so she tries to guide them with a gentle but firm hand. “Sometimes, a patient will know he needs to get his diabetes under control, but he’s so busy he’s just not ready. I try to be understanding of his needs and show him what he can accomplish even in times of stress.”
She developed her gift for simplicity over the last two decades while teaching interns, residents and medical students. Today, Gefter and the other members of her practice are all faculty members of the University of Tennessee College of Medicine in Memphis. When students there do their clinical years at Erlanger, they inevitably spend time with Gefter, whether it’s during their rounds or while attending one of her cardiology lectures. “I’ve always loved to teach,” she says. “It’s my natural inclination.”
To demonstrate her proficiency when explaining complex material, Gefter offers a Reader’s Digest version of her biography, which is storied, to say the least. She was born in China to immigrants from Austria and Russia, then spent her formative years in South America after her parents left China in the wake of the Communist Revolution of 1949.
After Gefter finished high school, she went to college in Boston, where she met her husband, Jeffrey, now a radiation oncologist at Erlanger. Upon obtaining her master’s degree from Harvard University, Gefter received her medical degree, internship and residency from the University of Florida College of Medicine.
“When we finished our residencies at the University of Florida, we both joined the faculty there,” Gefter says. “After a couple of years, my husband decided he wanted to go into private practice, so he started looking different places. When he came to Chattanooga, he got excited.”
The couple moved to Scenic City in 1982. Gefter joined the ranks at Erlanger immediately, and through the years has served in many different capacities, including vice chairman of the UTCOM Chattanooga Depart-ment of Internal Medicine. Now she’s in private practice and “loving it.”
“I just passed the hundred patient mark!” she says. “That’s big for me.”
Gefter says she plans to continue to build her practice, as she has no desire to do anything else. “This is what I want to do. I love the intimacy of being in a room with a patient, listening to what’s going on and making sure I focus on them and their needs. That’s very satisfying. When I go home at night, my husband always says I seem happy. And he’s right!”
To contact Gefter, call Academic Internal Medicine at 423-778-8179.
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