Nicholas J. Cristoveanu MD CCFP FCFP

William M. Glenn

The patients being admitted to nursing homes these days are sicker than ever before,” says Dr Nicholas Cristoveanu. “About 70% exhibit some degree of dementia or cognitive impairment. That’s the reality.” He’s observed the change first-hand. For the past 25 years, Dr Cristoveanu has served as Medical Director for the Rideaucrest Home for the aged in Kingston, Ont, in addition to his busy group family practice.

Dr Cristoveanu espouses a “no restraints policy”—either physical or chemical—whenever possible. “Drugs have to be used very judiciously,” he says. Rather than medicate, “we look for behavioural nuances and try to identify what might trigger outbursts. It can take a lot of detective work to identify a nonpharmaceutical solution.”

Dr Cristoveanu digs deep into his patients’ histories, relying on his years of experience and input from the other members of the Rideaucrest team, for ways to make a connection. “I had one dementia patient who could no longer speak, but if I got her singing, she could perform ‘Danny Boy’ in perfect pitch from beginning to end,” he says. “For a few minutes, you got a glimpse of the person she once was.”

His work at Rideaucrest has also been a great help in Dr Cristoveanu’s family practice. “Alzheimer’s is not a lump you can biopsy. You have to piece the clues together to complete a clinical picture,” he says. Having maintained his family practice since 1981, Dr Cristoveanu is now treating the children and even some of the grandchildren of his first patients. He has also watched his older patients age and slowly lose their independence. “Family practice provides continuity and a broader overview. Over the years, it reveals what’s going on in a family,” he says.

Dr Cristoveanu recalls a long-ago housecall, visiting a patient in the early stages of Parkinson disease. On the wall of his living room was a beautiful photograph of a golden retriever and they started “talking dogs.” When his patient’s deteriorating condition eventually brought him to Rideaucrest, “I remembered that visit and brought Fergus, our family’s golden retriever, with me into the nursing home,” Dr Cristoveanu says. “It was a wonderful experience for all of us.”

That’s how you make connections. Sometimes you see the big picture by remembering the little pictures on the wall.

“You have to piece the clues together to complete a clinical picture”

PHOTOS (LEFT): Dr Cristoveanu in the clinic (top) with Lisa Swain, his clinic assistant (middle left); Taryn McIntosh, one of the clinic staff (bottom left); and Judy Watters, a clinic nurse (right).

PHOTOS (RIGHT): Dr Cristoveanu enjoying the outdoors and his golden retriever, Fergus.

Footnotes

Dr Cristoveanu is a family physician at the Frontenac Medical Associates clinic and Medical Director for the Rideaucrest Home in Kingston, Ont.
THE COVER PROJECT Canadian Family Physician has embarked on a project to assemble the portrait of family medicine in Canada. Each cover of the journal features a family physician chosen at random from our membership list, along with a short essay—a brief glimpse of the person and the practice. Over time, the randomness will become representative and the differences, taken together, will define what it is that all family physicians have in common.