‘They deserve the best’: Culture is key to care for Cherokee geriatrician
Blythe Winchester has known since a young age that she wanted to be a doctor. She remembers “doctoring” her dolls as a child in Cherokee’s Wolfetown community, using the empty needleless syringes her father would bring home from his job as a social worker. The little girl would inject the toys with Coca-Cola, staining their plush bodies brown.
“It’s been for a very long time that I knew I wanted to be a doctor,” she said.
She tried to convince herself otherwise. It takes years of school, way too much money and extreme dedication to practice medicine. She tried to convince herself that she’d be just as happy somewhere else in the medical field — somewhere that doesn’t require an M.D. — and left a whole year between undergrad at Davidson College and med school at UNC-Chapel Hill as she tried to make something else stick.
It didn’t work. Winchester was meant to be a doctor.
Now 42 with 11 years of post-residency practice, Winchester is one of the only Native Americans in the country to specialize in geriatrics — which is itself a small and shrinking specialty.
“I’ll tell you that right now, I know that there’s like one other Native geriatrician in this country. And there might be more, it’s just there’s only one that I know of,” she said. “To be honest, I just want there not to be a need for geriatricians. I wish that all of the primary care physicians knew what I know and had that approach with elders so they didn’t even need a whole specialty for our elder population.”
Geriatrics is not a favored field within the medical community. It’s the only subspecialty that does not get paid additional money for completing a fellowship and becoming a subspecialist, Winchester said, which may be a contributing factor as to why 2015 data from the National Resident Matching Program showed that 56 percent of the nation’s 353 geriatric medicine fellowship positions remained unfilled, with only 19 percent of the available positions filled by doctors who had graduated from American schools. However, Winchester said, geriatrics tends to be the subspecialty with the highest satisfaction rate among practitioners.
Winchester checks in with her patient John Ed Walkingstick. Laci Nations photo
Winchester didn’t go to med school with the explicit aim of working with senior citizens. It wasn’t a specialty she really even heard about while going through her training. She finally stumbled upon it at the end of her family medicine residency at the Center for Family Medicine in Greenville, South Carolina, where she took a geriatrics elective.
“I just absolutely fell in love with everything about it,” she said.
In 2012, four years after finishing her residency, she began her geriatrics fellowship, and since completing that program in 2013 she’s practiced the specialty full-time. Winchester is a clinician at the Cherokee Indian Hospital, medical director at Tsali Care Center and chief clinical consultant for geriatrics and palliative care for the Indian Health Service. She lives in Cherokee with her husband and a menagerie of dogs and cats — it’s always been her goal to live where her roots are.
‘It’s just that important’
To Winchester, there’s nothing more rewarding than getting to know her patients and helping them to live out their later years on their own terms.
“In geriatrics, it’s always something different. It’s very challenging,” she said. “Because our older patients have so many different medical problems, they’re often on many medications, a lot of them they don’t often need. Their issues are with advanced care planning and looking at their futures and what’s going to be helpful for them to stay independent. So there’s just all these different issues, and sometimes you have to be a bit of a detective.”
Winchester loves the detective work. With older people especially, it’s important to know their background, what they did for work, their lifestyle, their medical history and the treatment they’re currently getting from other specialists — all the experiences they’ve had over the course of their life.
“Sometimes finding out something about someone’s background or history can make a huge difference in their care now,” she said.
That said, Winchester definitely sees her patients as people, not just puzzles. With decades of accumulated knowledge and experience, they know things that younger people just don’t. They have stories to tell, jokes to share — Winchester is constantly learning from her patients. She often finds herself upset by society’s obsession with and glorification of youth.
“It bothers me when people think that somehow older people are not supposed to still make dirty jokes, or still be interested in sex, or still want to drink wine and dance,” she said. “It’s these sorts of things. I really enjoy getting to know people and just encouraging them with whatever it is that they still enjoy in their life — in a safe manner, of course.”
That conviction spurs Winchester to go the extra mile for her patients, to be their advocate as they try to navigate the maze of specialists and red tape that people often find themselves dealing with as they get older.
“I think a lot of times our older population is not given the focus, the attention and the priority that they need,” she said. “I love being able to be the person who says, ‘No, this is important. We’re gonna make this happen.’ It doesn’t matter if I have to communicate that to other specialists, to medical equipment companies, to whoever it is. I’m also happy to be that advocate, because they deserve it more than anybody. They deserve the best care and focus and attention, especially our tribal elders. They have knowledge that no one else may ever have. It’s just that important.”
Winchester was chosen for the 2019 Remember the Removal Ride, cycling 950 miles to retrace the Trail of Tears to Oklahoma. Bear Allison photo
As a Cherokee woman, Winchester has a special respect for the importance of caring for the elderly. The Cherokee culture elevates and reveres its elders, because they are the keepers of tribal knowledge and wisdom.
“My culture and my role here as a member of this community, in this tribe, it affects everything,” she said. “And it should, really, when you think about it.”
Being a member of the community she serves gives Winchester a unique ability to connect with her patients and earn their trust. She’s one of them. Her grandmother Kay Sanders, a longtime teacher in Cherokee, doled out praise or punishment to more than one of her patients; her ancestors drew their sustenance from the same mountains that theirs did.
That said, Winchester is always trying to connect closer, to plant her roots deeper. A lifelong language learner, she’s always working to strengthen her Cherokee language skills, and she’s constantly trying to remind herself of the foundations of traditional health care, rooted in the trees and herbs that Native people relied upon for millennia before the European arrival.
In 2019, she completed the Remember the Removal Bicycle Ride, which retraces Trail of Tears. She’s also a graduate of The Right Path Adult Leadership Program and a member of their alumni program, which helps her continually sharpen her skills in culturally based leadership.
“Everything that I learn there, I just pull it right into what I do at work to help me make sure that I’m doing my job in the best way that I can and that I’m just being a strong Cherokee woman the best way that I can,” she said.
Fostering that cultural connection is more than just a feel-good goal. Multiple studies have shown that patients prefer doctors who share their race or ethnicity; The authors of a 2002 study that was the first to test whether the preference for same-race doctors actually exists suggested that the preference may be due either to greater feelings of trust and comfort with a physician of the same race, or to distrust of physicians from a different race.
Either way, it’s of vital importance for patients to have access to physicians that they’re most likely to trust — trust encourages patients to see their doctor regularly, and to be honest with them about information that could be key to successful treatment.
Those may be subjective generalizations, but it’s an objective fact Native Americans are vastly underrepresented in the ranks of medical doctors and that nationwide, the life expectancy for Native Americans is 5.5 years less than that of the overall U.S. population — 73 years versus 78.5.
“There’s no reason that should exist,” said Winchester.
Legacy of underrepresentation
The history behind that disparity in life expectancy is complex and multi-faceted, but the fact that Native Americans are the most under-represented race among American physicians certainly can’t help.
According to data from the Association of American Medical Colleges, 56.2 percent of all active physicians in the U.S. as of July 1, 2019, were White, 17.1 percent were Asian and 13.7 percent were listed as “unknown.” That’s vast overrepresentation for Asians, who constitute 5.9 percent of the overall population according to 2019 census data, and slight underrepresentation for whites, who constitute 60.1 percent of the U.S. population.
However, Hispanics, Blacks and Native Americans were extremely underrepresented. Only 5.8 percent of doctors were Hispanic despite Hispanics making up 18.5 percent of the overall population. Another 5 percent were Black, just 37.3 percent of the race’s 13.4 percent share of the population, and an infinitesimal 0.3 percent were American Indian or Alaska Native — just 23 percent of that ethnicity’s 1.3 percent share of the U.S. population.
That underrepresentation is even reflected at home in Cherokee, within the walls of the tribally run Cherokee Indian Hospital — of the 77 medical doctors, doctors of osteopathic medicine, physicians assistants and nurse practitioners at CIH, only five are Native American. That’s just 6.5 percent of the total, despite the fact that the hospital is located on the Qualla Boundary and that the population of Swain County overall is 30.1 percent Native American, according to 2019 census data.
“It’s more of a struggle for Native people from the very beginning,” said Winchester. “There are fewer of us that are even going to undergrad. Harder to be away from home, commuting to places — I mean, there’s just a huge number of factors involved.”
Despite her long-held conviction that she was meant to be a doctor, Winchester said that it was difficult, and isolating, to be the only Native American in her med school class.
Med school is hard, and for students from underrepresented backgrounds, it’s important to hear a clear message that their presence is welcome and even expected.
Progress is being made. In August, the first class of students arrived at the Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, the nation’s first tribally affiliated medical college. Winchester also applauds work being done by the nonprofit We Are Healers, which works to encourage and inspire young Native Americans to envision themselves as doctors, nurses and other types of medical professionals.
All about the patients
Winchester has found her place, but the work isn’t easy. It’s demanding of her time, of her mind and of her emotions. She works with older people, so by definition death is part of her everyday life.
“My patients die,” she said. “This is what happens, and so that’s difficult. By no means is this all just sunshine, flowers and candy. It’s a struggle.”
The support she receives from her boss, her coworkers and everyone else around her is vital to powering through the hard days and continuing to see the joy in what she does. In the end, though, it’s all about the patients.
“The patients are really why I continue to work so hard and spend so much time, because they’re really just such unique and fantastic people,” she said. “Almost every time that I sit and talk with one of my patients, I’m learning something from them.”