Turning up

Toby Commerford has settled in to life in Adelaide as a geriatrician, father, and yes, a rock singer …

GERIATRICIAN Dr Toby Commerford credits his mother with sparking his interest in the older members of our society.

“My mum was quite influential,” he tells the MJA. “She did volunteer work with old people and encouraged me to come along as well. We also had a very ancient lady living next door to us when I was a kid.”

Later he worked as a volunteer in a day centre for dementia patients in the UK, where he and his mother were living. But in the hustle and bustle of medical training, he forgot about how much he had enjoyed interacting with older people.

“In fact, by the end of medical school I was leaning towards adolescent psychiatry,” Dr Commerford says.

Born in Australia, but half-English, he returned to England to live with his mother, completing medical school at University College London in 2003. By 2004, he was back in Australia and training in Gosford when geriatrics came back into his working life. He’s never looked back.

“Most people think geriatrics is the least prestigious specialty in medicine. But those who do it are at the top of the job satisfaction lists.”

He and his Australian wife returned to England for 2 years of physician training, just in time for the British government to put a broad broom through the healthcare system.

“I couldn’t get a training job,” Dr Commerford says. And so, it was back to Australia, where he ended up in Ballarat, working under the supervision and mentorship of Dr Mark Yates.

In 2009 he was back in Melbourne doing a year of advanced training, but it was a terrible time for Dr Commerford and his wife, suffering the loss of their young son.

“It was very difficult,” he says. “Things happened that I couldn’t help, and I was just miserable. Someone told me that Adelaide was a great place and I had good childhood memories of the Adelaide Oval.”

On such memories are big decisions based and Adelaide has been his home ever since.

Geriatrics challenges him every day, he says.

“They are always incredibly complicated cases. They have complex medical issues, webs of problems accumulated over years, like the world’s most untidy room. And, in a similar way to paediatrics, they are very vulnerable patients.

“They’re a very specific cohort, often vulnerable to abuse, often brought in by someone else. They present differently than other patients, sometimes with delirium.

“I have to use my brain every day.”

The healthcare system was not built with Australia’s oldest citizens in mind, Dr Commerford says.

“We’re rescuing complex people. Someone called it ‘salvage’ work. The system is so poorly designed for them – we’re salvaging them from system issues a lot of the time.”

Sometimes geriatrics are misunderstood by their doctors, he says, and others “scupper” their own care.

“There’s an under-reporting of their illnesses, because people say, ‘oh, it’s just old age’. There’s a distinction between the processes of old age, and illness. Old people get sick more often but it’s under-reported. Even though there’s an obvious, predictable sequence of events, they don’t see it.”

Although he is a consultant in geriatrics at the RAH, Dr Commerford is almost never there. These days he is the Head of Community Geriatrics, conducting home visits with a multidisciplinary team to the most complex cases. He is also a teacher at the University of Adelaide, and conducts monthly outreach clinics in rural South Australia.

Geriatrics, he says, “can be dreadfully depressing sometimes, of course”. When it is, he gets through “by thinking that at least I dealt with something that few would want to”.

“It’s about getting reward out of your own fortitude. I turned up.”

So, what does a busy geriatrician with a young family do when he’s not looking after old people? Sing in a band, of course.

Dr Commerford is lead singer of four-piece original rock band Deflector. According to the band’s Facebook page “their sound draws from many influences including Stone Temple Pilots, The Pixies, Aerosmith, The Beatles, RHCPs and The Darkness”. Their debut EP “Dancing about architecture” was released in 2014.

“It’s a busy life and I’m pretty lucky,” he says. “I feel like I’m at a point I never foresaw I’d be at in my late 30s, early 40s. I’m getting stuff done – looking after two kids, working, writing, doing music gigs, recording.”

Does he recommend geriatrics to his students?

“Absolutely, but I don’t expect them to do it,” he says. “All I ask is that they wait until they’ve done the whole year – hopefully they’ll realise at the end of it that it was actually pretty good. That’s the beauty of my role. I can show them how different it is from their expectations at the start of the year.”