A New Model for Healthy Aging: The Multidisciplinary Board Approach

Healing starts with how we make people feel. In the last two years, I have worn many hats: comedian, movie critic, book reviewer, conflict resolution mediator, neuro-economist, healer, listener, teacher. To some what starts as 'kaffeeklatsch' or 'chitchat' with my patients is nothing but a relaxed introduction into active listening. The art of truly earning a patient's trust to walk alongside them shaping their future, demands respectful silence. And time.

The physician of tomorrow isn’t just a medical expert; but a creator of teams, a leader who understands that the future of truly practicing "medicine" is multidisciplinary. This approach doesn't apply only to patients in clinical settings—it extends into the very personal care of our loved ones. I am a mother, daughter, and a friend first and foremost. In all those roles I failed, took a different approach, asked for forgiveness and learned to be present. These roles taught me how to be a better doctor, by setting aside my ego and giving others center stage.

For my mother, I have surrounded her with her own care board, each member playing a crucial role in her comfort and emotional well-being. Her palliative care doctor visits weekly, ensuring she is comfortable and able to enjoy her day as much as possible. The physical therapist increases her oxytocin levels through gentle touch—massage, lymph drainage, and encouragement to move just a little each day. And as oxytocin rises, so does dopamine motivating her to start her day, and serotonin allowing her to stop, wonder, enjoy the little moments. These moments of care help ease pain and fear; creating connection, fostering resilience through love and touch.

I visit her often, bringing the outside world into her four walls. I tell her about my patients, share stories from my day, and let my puppy jump onto her lap. The pure joy my puppy brings—licking her hands, offering unconditional love—is a gift that no medication could replicate. For an instant the weight of her illness seems to lift.

My cousin from Romania stays by her side every day, telling jokes that make her laugh and cooking meals from her childhood. The smells, the tastes—they transport her to lighter days, allowing her to dwell in the warmth of memories and gently push away the burdens of her current reality. She is not defined by her illness but by the fullness of her life and the love that surrounds her.

This deeply personal experience has taught me what every physician must aspire to create for their patients: a team that addresses not just the medical, but the emotional, spiritual, and practical aspects of life. In my mother’s case, it’s a blend of medicine, touch, companionship, laughter, and memory.

Whether in a medical office or in a loved one’s living room, the power of a multidisciplinary approach combined with the intentional act of dreamweaving—creating moments of peace, joy, and care—is what makes the journey not just bearable but beautiful. A week of vacation on the beautiful shores of Pine Point Beach in Maine has allowed my thoughts to wander. And crystalize my dream of the future of medicine, rooted in the concept of unreasonable hospitality, a philosophy championed by restaurateur Will Guidara , to become a dreamweaver. My legacy - an effort to make every patient’s experience truly exceptional and transformative.

As a physician, I’ve spent years grappling with the complexities of aging and its impact on physical, cognitive, and emotional health. Increasingly, I find myself asking: How can I address the unique, interconnected challenges faced by older adults more effectively? The answer, I believe, lies in a collaborative, multidisciplinary approach that mirrors the format of a tumor board — a model where each patient is reviewed holistically by a team of specialists, and each perspective shapes the course of care, giving it structure and predictability. We all need these two elements to root our existence.

In the realm of cancer care, tumor boards have proven invaluable. Each patient's case is presented to a panel of experts—oncologists, radiologists, pathologists, and surgeons, geneticists, pharmacologists, social workers, palliative care MD's—each contributing their expertise to create a tailored treatment plan. Why not extend this concept to the broader and equally complex issue of healthy aging? With this model in mind, I want to focus on the notion of a Healthy Aging Board, where patients facing depression, cognitive decline, or other age-related challenges (cancer, ASCVD, metabolic dysfunctions) are evaluated by a diverse team of specialists, each offering insights that together build a comprehensive but strikingly different proactive care plan, empowering the patient.

In a playful way, let me use the proven and robust interplay between depression, cognitive decline and dementia as an example to share what such a board might look like. Asking questions from different perspectives is what could takes us on an elegant and exciting new learning journey with the patient at it's center. Based on the different perspectives I applied to the solutions crafted for my patients in the last two years here are the players I would want crafting patient plans on my Healthy Aging Board:

The Neuroscientist’s Perspective

A neuroscientist on the board would begin by reviewing brain imaging, perhaps from functional MRI scans, to detect any early signs of neurodegeneration. For patients with depression, the question would be: How does brain activity differ between those who develop dementia and those who do not? The neuroscientist would also assess the role of brain-derived neurotrophic factor (BDNF), a protein crucial for neuroplasticity. They might ask: How do interventions like fasting, ketogenic diets, or resistance training affect BDNF levels, and could these be used to reduce both depression and dementia risk?

They would make the effort to explain complex neurological concepts in a way that is not just understandable but deeply personalized to the patient’s concerns and curiosities. What can we show you about your brain that will empower you to feel hopeful? This conversation, rather than a sterile presentation of data, becomes a moment to establish connection, affirm the patient's intelligence, and invite them into the discovery process.

The Geneticist and Epigeneticist’s Contribution

The geneticist or epigeneticist would then explore the patient’s genetic predisposition to both depression and cognitive decline. Are there specific genetic polymorphisms—such as those affecting the CYP450 enzymes—that alter the metabolism of antidepressants? This information could determine whether pharmacological treatments are appropriate or if alternative therapies are needed, as well as allow individualized dosing for optimized results, and minimized medication side-effects. Additionally, they’d investigate whether genetic markers related to neuroplasticity could inform long-term treatment plans, possibly indicating how well a patient might respond to lifestyle or pharmacological interventions.

Instead of presenting genetic data as a list of risks, the geneticist could translating the information into a story about the patient’s unique biological heritage. How can we make your genetic story feel like a journey toward health and empowerment, not a list of predispositions? By framing genetic information in terms of resilience and opportunity for positive lifestyle changes, the geneticist fosters a sense of agency and hope.

The Molecular Biologist’s Inquiry

The molecular biologist would bring a different lens, looking at underlying biological processes such as the role of the gut-brain axis in mental health. Could amyloid plaques be traced back to microbial activity in the gut, reaching the brain via the vagus nerve? If so, how might modifying the patient’s microbiome alter their risk profile? Additionally, they would explore serotonin levels in the context of depression, asking: Are low serotonin levels an early marker of both depression and cognitive decline, and how can they be addressed through targeted therapies? or How can we transform complex biological pathways into a compelling narrative about your body’s ability to heal and adapt? This effort goes beyond just delivering information; it's about crafting a conversation that touches the patient’s curiosity and wonder, ultimately triggering a release of oxytocin as the patient feels connected to their body and the care team.

The Nutritionist’s Assessment

A nutritionist would take a close look at the patient’s diet and metabolic health. Are key amino acids like tryptophan, glutamate, or phenylalanine deficient, and how might these deficits contribute to both depression and cognitive impairment? Could dietary adjustments, such as increasing the intake of certain micronutrients or adopting a low-carb/high-fat diet, have a protective effect on the brain? By tailoring a nutrition plan to optimize gut and brain health, the nutritionist plays a crucial role in reducing long-term dementia risk.

For the nutritionist their task might take the form of customizing dietary advice that aligns with the patient’s favorite foods or cultural heritage while still addressing nutritional needs. How can we make this dietary plan not only medically sound but also something that brings you joy and comfort? The patient leaves not just with a list of foods to avoid but with a meal plan that excites them, turning nutrition into an act of self-love.

The Sports Physiologist’s Review

The sports physiologist would review metrics such as VO2 max and body composition, focusing on the connection between physical fitness and mental health. How does loss of muscle mass or cardiovascular fitness correlate with increased depression and cognitive decline? The physiologist would provide insights into how regular exercise, especially resistance and aerobic training, could not only improve physical health but also mitigate the risks of both depression and dementia.

Exercise is often seen as a chore, but what if it could feel like a personal gift? The sports physiologist could embody this by crafting a fitness plan based on activities the patient loves, whether it’s dancing, swimming, or hiking. How can we create a movement practice that feels more like play than exercise? By asking the patient about their physical preferences and past experiences with movement, the physiologist turns exercise into an emotionally rewarding experience.

The Psychologist’s Approach

From the psychologist’s perspective, it’s important to identify the external factors contributing to depression. What are the life circumstances, stressors, or unresolved traumas that might be fueling the patient’s mental health challenges? The psychologist would recommend psychosocial interventions, such as cognitive-behavioral therapy (CBT), that have been shown to alleviate depressive symptoms in older adults. Moreover, addressing emotional resilience through therapy might provide a pathway for improving overall cognitive health.

How can we work together to make therapy feel like a safe, nourishing space where you are truly heard? Small touches—such as having a favorite warm drink ready when the patient arrives, or remembering a detail from their personal life to check in on—make the patient feel deeply cared for.

The Yoga Teacher/Meditation Coach’s Calming Strategies

Finally, the yoga teacher or mindfulness coach would focus on the emotional and psychological well-being of the patient. How can we use mindfulness practices to quiet the internal "chatter" that often accompanies depression and cognitive dysfunction? Techniques such as guided meditation, yoga nidra, and progressive muscle relaxation can play a key role in reducing stress and promoting neuroplasticity, offering a non-invasive, effective intervention for mental and cognitive health.

How can we make mindfulness a treasured part of your day, something that feels like a gift to yourself? The yoga teacher might design a short, personalized meditation for the patient to listen to at home, creating a sense of continuity and emotional support between appointments.

The Writer’s Creative Input

A writer in this multidisciplinary team would serve as a creative force, attending board meetings to help shape the narrative of each patient’s case. Their role is not merely artistic; it’s about ensuring that the patient’s story is told in a way that allows the medical team to generate the most insightful, nuanced approaches. They might ask: What questions have we not asked yet? By carefully crafting prompts and reframing the patient's journey, they guide the team toward a more personalized, empathetic approach.

The Artist’s Disruptive Perspective

An artist would provide an invaluable outside-the-box perspective. Could creative thinking reveal unexpected solutions for complex, multifaceted problems like depression and cognitive decline? The artist would encourage the board to challenge assumptions and think laterally, potentially offering disruptive ideas that lead to novel interventions.

The Physician as Conductor or Chief Dreamweaver

As the doctor overseeing this multidisciplinary board, my role would be akin to a conductor, perhaps merging a bit of the writer and artist persona's and integrating these diverse perspectives into a unified care plan. Listening to each expert’s input enables me to tailor the patient’s treatment holistically, considering everything from their genetic profile and neurobiology to their diet, exercise, and emotional well-being. This approach would allow us to craft a personalized, patient-centered plan rooted in personalized risk prediction, prevention, active listening, and supported by patient triggered follow-up. Unreasonable hospitality in this context means never settling for “good enough” care, but always asking: What can we do to make this experience extraordinary?

From small gestures of kindness to larger acts of personalization, this approach can create a healing environment where patients feel genuinely cared for, emotionally connected, and hopeful about their future. Ultimately, the goal is to turn the patient-doctor unit into a partnership, where every patient feels like the most important person in the room, and every interaction is an opportunity to foster trust, joy, and healing.What can we do to make this experience extraordinary?

In the end, we heal by caring beyond the clinical.

Thoughts?