Helping people live healthier lives: Physician discusses her appointment to chair the department of family medicine in the Jacobs School of Medicine and Biomedical Sciences
Q: You’re now the chairwoman of the department of family medicine in the Jacobs School of Medicine and Biomedical Sciences after having held it as an interim position. What made you want to take it on long-term?
A: We can start with why I wanted to be the chair. It’s a bit of a lifelong professional dream. I started my career at Buffalo medical school and my residency out in rural practice for a little while. I’ve also been faculty at the school of medicine in different roles, roles that included the design of medical student education curriculum and the evaluation of that curriculum — essentially being the director of medical student education in the department of family medicine and the director of residency education in the department of family medicine. I had a good, professional relationship with the chair at that time. He was very solid in the role. His name was Jeffrey Thomas Rosenthal. And I was called by a recruiter to serve as family medicine department chair at SUNY Upstate in Syracuse. So in 2006 I went to Syracuse and led that department from 2006 through most of 2011. I got married and returned to Buffalo for family reasons. I felt like I left the Syracuse department in pretty good hands.
Q: What happened when you came back to Buffalo?
A: When I came back to Buffalo, there was still someone in the chairman role. So I served under the title of associate dean of student affairs. What that basically is is a guidance counselor of sorts for medical students, counseling students if they’ve had any economic difficulty and, more importantly, counseling students and helping them if they’ve had academic difficulty and, most importantly, helping them launch from medical school to a residency program. I’d write what’s called a dean’s letter, which is an institutional transfer letter. I served in that role for 10 years, until the end of 2021. The chair of the department announced he was stepping away from the position after eight years in the role. So it was at that time, immediately post-pandemic, I said I’d be interested in the role, put together a proposal and was appointed the interim chair of the department of family medicine. A few months later the dean changed. I let her know I’d be happy to stay on permanently. There was so much influx in the medical school at the time that I think she was happy to have some stability. So that’s how I got here, long story. I have the experience of having been a chair even though the department in Syracuse is much smaller, but I also have a track record at Buffalo.
Q: Can you tell us some more about your curriculum development?
A: Approximately 24 years ago there was an effort to update the curriculum. There had been a course we might call, in a friendly way, Doctoring 101. It began in the second year of medical school. So I led the design of clinical skills course for first-year students. In other words, while they’re learning the hard sciences, at the same time they’re learning how to communicate with the patient, take medical history, do a physical examination. That was the goal of the first-year course. We weren’t teaching them how to differentiate between heart murmurs; we were making sure they knew how to put the stethoscope in the right place, to be able to conduct a physical examination on a healthy patient. The course incorporated some lectures, small group learning and working with standardized patients. These are people who are basically actors who are trained to act like patients. So the students and their colleagues could get together and practice their examination skills. And we took it farther in the assessment part of the course, which would happen in an examination room with faculty looking on and evaluating them.
Q: You have a background in caring for complex medical conditions. What kinds of things does that include?
A: That includes a complexity in any given individual. So it’s not a specific disease that’s complex but, for example, taking care of a senior citizen Medicare patient who has a long list of medical problems. I think the single most important thing in family medicine and primary care is to take a very patient-centered approach to care, taking care of the patient and their family within the context of their family and community.
Q: When it comes to preventive care, lifestyle changes always seem like the hardest to implement. Is there an effective strategy you’ve found for helping patients make those changes and getting results from them?
A: I think it’s respecting the patient, respecting their goals and their capacity and coaching and guiding them into a healthier life year over year. I’ve been known to say to people that I want to see that they’re healthier this year than they were last year. And maybe that’s medically healthier: their numbers are better. But it could also mean that they’re happier. That they’ve made some dietary changes. That they have a bit more activity in their lives. Gaining a calendar year doesn’t necessarily mean that they’ve lost a year of health.
Q: The pandemic was a bit of a disaster when it came to managed conditions and screenings. How have you gone about getting people whose conditions have decompensated back to health?
A: So I can speak primarily for our private practices: we were up and running telehealth visits on patients within 10 days of closure. So although people might think that can’t work across a computer screen, but if you’ve known the patient for many years you can still do all the history taking and ask them questions like you could in office. On top of that, most of the patients had a smartphone and could hold their phone to their ankles to show me if they had swelling. They could hold the phone to a knee if they had an injury, to a rash. It was obviously imperfect when it came to listening to heart and lung sounds. It was very good for looking in the mouth. It was impossible to look into an ear or palpate a lymph node. But there was so much that you could do.
Q: Were there any surprises with telehealth?
A: A hidden and unexpected benefit was that you were making a pseudo-health call. You could get a sense of the patient’s living circumstances. I recall having a telehealth visit with a single mom who was working from home, had a child in a playpen, another in her arms. So it increased the understanding of home life and community life.
Q: As a physician, what can you do with that information?
A: The first thing is to be supportive. “It looks like things are stressful in your home right now, is there anything we could do to help you manage your work?” And then, in the long run, when you see them back in the office you remember what you saw and you have the context of those pseudo-health calls to their ongoing care. Yes, some people gained weight during the pandemic. Most people maintained their medications and prescriptions. Some people actually improved their health and started running for the first time, or were able to use the exercise bike in the next room on their breaks. Some of them may have started cooking for themselves for the first time instead of eating at restaurants. So it was a mixed bag.
Name: Andrea T. Manyon, M.D.
Positions: President of UBMD Family Medicine and chairwoman of the department of family medicine at the Jacobs School of Medicine and Biomedical Sciences at the University
Education: University at Buffalo
Affiliations: Erie County Medical Center; Kaleida Health
Organizations: Society of Teachers of Family Medicine; Association of Departments of Family Medicine
Family: Married, blended family with eight children, three grandchildren
Hobbies: Activities at Greek Orthodox Church; sewing; cooking