Passion and Purpose: Cherokee Geriatrician Blythe Winchester on Choosing Geriatrics

Blythe Winchester is a woman of many passions, but two stand out—a great skill with and desire to give indigenous elders the best medical care possible, and an abiding need to ensure she incorporates her indigenous heritage into that work, as a geriatrician.

Winchester, 43, 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 with her husband, a couple dogs and a cat in Cherokee, NC. Cherokee is her ancestral home in that she grew up where she now lives, in the community of Wolftown, and in that Cherokee is on tribal land purchased in the mid-1800s by the Eastern Band of Cherokee Indians, to which she belongs.

Growing up, Winchester said she wanted, as kids do, to be a ballerina/pediatrician. And later tried valiantly to interest herself in studying anything but medicine, except everything she did—high school science camp, summer programs—just made her desire to be a doctor stronger. She took EMT training, worked in Emergency Services as a switchboard operator, all “to see if there was something else I might do; but there wasn’t.”

Competing Against the Privileged

She left Wolftown to attend Davidson College in North Carolina, where she spent a semester abroad studying marine biology, again trying not to become a doctor, but it didn’t stick either.

College in general was a struggle as she was competing against kids who had attended elite private schools. She had trouble with standardized tests and faced tough pre-med coursework. Plus, “being in a big city was hard, as I’m a country mouse,” Winchester said. But she could always count on the support of her family, and her desire to become a physician outweighed all the struggles.

Winchester fell in love with geriatrics during her residency.

“The only time I didn’t have difficulty was when I started residency,” Winchester said. “When I became an intern everything magically clicked into place, despite the difficult hours, and the workload, because there was something else you had to use in residency training—” and that was an ability to foster relationships with patients, other residents, nurses and attending physicians. At that, Winchester excelled.

“There’s something about my desire to have good relationships, being trusting, and more flexible, there’s something about my demeanor and skills in that area that allowed me to love residency, once I was doing the clinical work,” she said.

It wasn’t always smooth sailing as bias was evident and she encountered some blatant anti-Indigenous remarks that she now refers to as “just toxic times. It’s all part of some weird passage into the medical world—getting a thick skin, to be able to deal with what we all have to handle,” she said.

During residency there was no routine exposure to geriatrics, but she was able to take an elective and chose a continuity clinic in a nursing home. “From the minute I started, I had a few great mentors, exposure to what you do in geriatrics, and gained knowledge of the required work in long term care. I just fell in love with everything about it.

“How complicated it is, the complexity of helping people age well in a variety of places, trying to be their advocate, which you do more in geriatrics than in other disciplines,” said Winchester.

She revels in the advocacy part of the job as she, like many geriatricians, tends to root for the underdog.

Recruiting Future Geriatricians

Winchester is not, as has been rumored, the only geriatrician who works in the Indian Health System, but she knows of just one other indigenous geriatrician. The dearth doesn’t stop her from always asking around in the hopes of running into more geriatricians who share her type of patients. But what she’d really prefer is if there weren’t a need for geriatricians at all.

“I can understand how we have specialists to deal with certain age groups,” said Winchester, “but because we have such a shortage of geriatricians and such a need, going forward, we’re not going to be able to accommodate the need. The best way to accommodate geriatrics is to better equip primary care people, as there are far too many pressures on our time.”

There is no magic procedure through which geriatricians can receive the massive reimbursements required to make the field more attractive to more candidates, and primary care practices are not well set up to be geriatrics practices, which Winchester thinks would be the best way for elders to get the services they need.

To help remedy the situation Winchester continually educates professionals on what’s needed, and says age-friendly health systems (like those proposed by the Institute for Healthcare Improvement and the John A. Hartford Foundation), work, and are the best way to gain enough help for all the older adults in need. Winchester also works continually to woo others into the field. “I’m always the recruiter with med students and residents,” she said.

“I try to help others understand how much fun it is [in geriatrics], there’s such a high satisfaction rate. You get to take time being with patients, there isn’t the constant crank of patients you get with primary care. You get to visit in their home environment, you get to advocate, and you get to hear wonderful stories as you help people age as well as possible.

‘I try to help others understand how much fun it is [in geriatrics], there’s such a high satisfaction rate.’

“You help them with their goals of care and ensure they get to do what they want. So much medical care is driven by data, and often the treatment is what people don’t want. But in geriatrics, you get to do what they want. They may have a limited number of years left, so you ask how they might like to spend them and how you can help them do that,” Winchester added.

She calls her connection to her patients a gift—to have a relationship with someone, to hear the vulnerable places they’ve been and to feel connected. “Whether in clinic or in the nursing home I’m constantly amazed by what awesome people our tribal members are and what they’ve been through,” Winchester said.

Incorporating Her Indigenous Heritage

Her patients also have played a huge role in helping her to reconnect with her tribe and to incorporate her indigenous heritage in her work. She is learning the Cherokee language and participates in other cultural lessons. In 2019 she was selected to join a three-week, 950-mile Remember the Removal bike journey from Georgia to Oklahoma that retraced the northern route of the Trail of Tears, for which she trained not only on the bike, but also by learning the history, her lineage and language.

“It changed my life,” Winchester now says of the ride. “My interest in and connection to my roots grew that much deeper.”

Winchester researches and has written papers on frailty, dietary beliefs and diabetes in indigenous communities, and she participated in The Right Path, a leadership program to provide ways for Eastern Band of Cherokee Indian tribal members to learn Cherokee history and culture, and to develop leadership skills. In 2021 she was selected to participate in a year-long Kituwah Ways program, where Right Path graduates continue learning language and culture, while planning a community project.

As far as how she manages her time considering her two paid gigs as a physician, her geriatrics consultant job and her tribal work, Winchester said, “My husband and I don’t have children, so our friends joke that my children are all the people I help.” Also, she said, “I don’t know how to tell you how I get all the things I do done. Except to say I’m an aggressive person in terms of problem-solving and decision-making.”

She also seems to gain strength and determination listening and learning from her older patients as they pass down valuable life and Cherokee culture lessons. Undoubtedly, they benefit from her care and commitment as well.

Alison Biggar is ASA’s editorial director.

Photo (top): Dr. Blythe Winchester at the Cherokee Indian Hospital in Cherokee, N.C., courtesy of Chris Record.