Dominic Cestoni shares a laugh with UC Irvine first-year medical student Nina Narasimhalu during an October visit at Cestoni's home. He is helping young med students learn how to better deal with older patients through a new program at UCI.
In the next decade, aging baby boomers will account for four in every 10 doctor’s office visits. UC Irvine’s medical school is trying to gear up for that. It wants its first-year medical students to learn how to be comfortable with an older patient population. To make that happen, the students are teaming up with senior mentors.
On a late October day, first-year medical students Cassidy Vuong and Nina Narasimhalu walk through the door of an assisted-living center in Fountain Valley.
This is 95-year-old Dominic Cestoni’s home. He’s sitting on a couch across from a fish tank, with his walker and printed notes nearby. Cestoni is a genial man – and a proud Italian.
“Oh by the way, have you girls had lunch? I can have the girl make a quick Italian dish for you," Cestoni offers. "Would you like that? Pasta?”
This is the first time the med students have visited Cestoni at his home. They are here to learn from him how they should treat older patients once they become doctors.
"Look, I love to work with you guys," Cestoni says to the two young women. "It makes me feel good, OK? When you’re 95 years old, not many people can get this far."
Even at 95, Cestoni is active and inquisitive. He was the first in his family to get an iPhone and an iPad. He uses it to read the newspaper – and check his stocks.
And he has a clear idea of what he wants med students Cassidy and Narasimhalu to learn. At the top of his list: be friendly with patients; even if it’s as simple as knowing a patient’s favorite baseball team and chatting about last night’s game, do it.
"I hate to see a doctor who behaves like a doctor," Cestoni says. "Just because he’s got a title doesn’t make him any better than me."
Over an hour or two, Cestoni shares his medical conditions – and all kinds of other stories – with the med students.
Cassidy and Narasimhalu are blown away that he’s so positive, despite congestive heart failure and a catheter that has to be replaced each month.
"How do you manage to stay so positive and have a good sense of humor?" Narasimhalu asks.
"You have to have a sense of humor! I always have. Nobody else in my family has," Cestoni says as everyone laughs.
The idea behind the senior partner program for UCI first-year med students is to break misconceptions the young students have about older people. They visit the seniors at home, go with them to their doctor’s appointments and as a finale, they do something fun – senior’s choice, whether it’s baking or gambling.
Dr. Sonia Sehgal is in charge of the program. She says it is funded by grants. The program is patterned on a pilot program UCI tried out about a decade ago.
"I think the program offers something that they can’t really learn out of a book," Sehgal says. "Really, just a true patient experience and life experience and living with a chronic condition. There’s no way to substitute that first-hand information that these students will get from their senior partner. You can’t read it in a book. You can’t tell that experience to somebody as a professor or teacher. They just have to experience it."
Sehgal says the students will learn from their older mentors not only their medical history, but what it is like to age gracefully
She says just after the students were introduced to their senior mentors for the first time, a couple of the students came up to her, totally surprised. They had thought aging meant you “were just closer to death.”
"I had two students come up and express their amazement, really, that their senior partner loves life and wants to be active and is engaged in the community," Sehgal says. "So our hope is that at the end of the program, all of these students will have this understanding."
Narasimhalu already gets that. But she wants to understand how to foster patient relationships when you only have 15 minutes to see them. She says that’s tough with older people who have multiple conditions.
"So much of the elderly population is marginalized and I feel like they honestly need the people just to be able listen to them and reach out to them and hear what they have to say," Narasimhalu says. "And I feel like being able to offer that time and support is something I really want to learn."
Narasimhalu, who’s considering going into geriatrics, says she enjoys hearing the stories of older folks like Dominic Cestoni.
"I feel like right now, we’re so young that it’s easy to get lost in this mindset of where we are right now, but they can see everything in the bigger picture," Narasimhalu says with a nervous laugh. "And I feel like it’s comforting to be in their company."
Several students have already asked if they can continue their senior mentor relationship through medical school – something many of the seniors say they’d gladly do.