LMA—From patient life expectancy to professional gender norms, Doctor Donna Younger has seen a lot of changes in her 50 years treating patients at the Longwood Medical Area’s Joslin Diabetes Center.
“Things are remarkably different,” said 82-year-old Younger, who started working at Joslin on a fellowship in 1959 and joined the staff in 1961, mostly working with pregnant women, new mothers and infants in the center’s perinatal clinic.
“I am sure everyone knows people with insulin-dependent diabetes who are sticking their fingers all day every day” to draw blood to test their blood sugar levels, Younger said. “When I started, comatose patients would come into the ER and we would draw blood and send it to the lab. We would be lucky if we got it back in half-an-hour.”
The Joslin Center at 1 Joslin Place, was founded in 1898 by Dr. Eliot Joslin, who, among other things, pioneered the use of insulin to treat diabetes.
Technological advances, including innovations made at Joslin, have played a huge role in improving care for patients with diabetes, Younger said. But Dr. Joslin also played a key role in changing how patients and caregivers relate, she said.
One of his biggest innovations was that he “involved patients in their care plans” by methods as basic—and now universal—as insisting that the names and doses of drugs being prescribed be written on the vials, she said.
The Joslin Center also pioneered in recognizing the importance of nutrition and exercise in diabetes management, and passing that information on to patients in regular classes at the center, she said.
That approach to care was unusual when Younger started out. Back then the extent of diabetes treatment was generally to “keep patients out of a coma,” Younger said.
She listed a litany of formerly commonplace diabetes-related complications—from blindness to kidney failure—that are now rare thanks to work by work by Joslin researchers. She also noted that the life expectancy and diabetic infant mortality are no longer statistically distinguishable from the population at large.
But, she said, her biggest surprise is that diabetes has not yet been cured.
“I had expected that things would have progressed farther—if not curing than at least for managing it,” she said. She said she believes that advances in digital blood-glucose monitoring and automatic insulin delivery combined with gene therapy or other fine-tuning of human physiology will soon mean that doctors can rig diabetes patients’ bodies to automatically self-correct their blood-glucose levels in real time.
While Younger’s focus at Joslin was working with diabetic mothers and infants, because there were relatively few practicing female doctors at the time, her services as a general practitioner were also in demand.
“Even though it was a diabetes clinic, there were a number of women who came just because they wanted a female physician,” she said. She also served as Dr. Joslin’s personal physician, at his request, when he was hospitalized in 1961, at the age of 92.
On the other hand, some women she saw were surprised to find out they were being treated by a female doctor, but men never were. “The people at the front desk would always ask male patients if they were comfortable being seen by a female,” she said.
Younger said she was the second female physician Joslin hired to run Joslin’s perinatal clinic. The first was Dr. Priscilla White who started at the clinic in 1924. “He thought women [doctors] would be better with pregnant women and children,” Younger said.
Today, she said, she is mostly retired, just seeing a few long-time patients. “It really is great that they let me continue to participate, and see these people who I have known and cared for over decades and decades…I delivered their children and now we talk about their grandchildren.”