PHYSICIAN SPOTLIGHT Amanda G. Smith, MD
Medical Director, USF Health Byrd Alzheimer’s Institute
TAMPA - Amanda Smith gained an appreciation for older adults when she was hanging out at Chatham Acres, the suburban Philadelphia nursing home her grandparents owned. “They were very active, always busy, social and doing things for charity,” said Smith, who remembers visiting there often when she could take a break from her studies at Jefferson Medical College of Thomas Jefferson University.
“I found that I really liked being around older people. I respected their lives and their life stories and enjoyed talking with them. Too many people are afraid of talking to older persons, but I love it. ... They have been so many places and done so much. I found that I sought out opportunities to spend more time with them,” she said.
That appreciation evolved into an epiphany as she was doing a rotation at Bryn Mawr Hospital. “A woman came into the ER from a nursing home supposedly with chest pains. The attending physician brought me in to determine what was going on. I talked to her and she told me she was at lunch and had a sharp pain run down her arm,” Smith remembered. “I presented (that information) to the attending and he jumped to the conclusion that (the patient) didn’t know what she was talking about. ... He was ready to write her off as confused and old,” Smith said.
It turned out that “the only problem was that the EMS workers didn’t bring her dentures, so she sounded funny when she talked. I was so mad!” she said. “It set my course for my electives in med school,” said Smith. “I started to find there was a real attitude of ageism in medicine. It seemed that my attending physicians often felt it was ‘normal’ for people to be confused or depressed just because they were old. From my (personal) experience, I knew that wasn't right and I wanted to do something about it,” she said.
Indeed, Smith’s career trajectory has landed her in a place where she now can do plenty to improve both attitudes and treatments for her patients.
After earning her MD in 1997, Smith accepted an internship in psychiatry at the University of South Florida College of Medicine in Tampa. Her parents owned a home in Long Boat Key, where she had spent every summer since she was 10 years old. “I was sort of a part-time Florida resident already, and after medical school I was done with winters,” she said. Sarasota also is where she had met her husband, Sam, in 1993. The couple married in 1997 while she was completing her internship. A three-year residency in general psychiatry at USF followed, as did a fellowship in geriatric psychiatry. A rotation in that capacity led to a seven-year clinical career at the USF Alzheimer’s and Gerontology Center and the Eric Pfeiffer Suncoast Alzheimer’s Center, which eventually became the USF Health Byrd Alzheimer’s Institute, where Smith is now medical director.
In that capacity, Smith is an integral member of a multi-disciplined team of physicians, researchers, academic and support staff who are at the scientific vanguard of virtually every aspect of memory disorders and dementia. “One of the things that makes us unique is we are a true translational center. Some of the (work) they have done in the labs has been brought to the clinic in pilot studies for patients. We can do all of this without stepping outside the building.
We’re one of the only places in the world where that can happen. ... This model does not exist anywhere else,” she said.
“We are doing a lot of exciting things at the Byrd Institute,” said Smith, 42. One of the things we are starting to understand about Alzheimer’s disease, and medicine in general, is that people respond differently to medication. Some of this has to do with our genes. We are working on some projects that will hopefully help lead to a personalized medicine approach for treatment. If we understand who responds to which medicines and why, we can tailor treatment to their specific makeup and perhaps have more success than we’ve had in the past,” she said.
Another recent advance is the FDA-approved use of Amyvid as a radiotracer that shows, in a PET scan, amyloid plaque in the brains of patients who are suspected of having cognitive impairment such as Alzheimer’s disease. The scan “can show the plaque in the brain with rather remarkable accuracy,” Smith said. Doing so will enable her and her colleagues to administer drugs that might postpone the onset of dementia rather than trying to treat it once it is full-blown. “It might revolutionize the whole field” of treatment, she said.
The tidal wave of the baby boom generation dictates the need for different approaches, Smith said. “People have considered dementia as a natural consequence of aging. ... It’s been sort of a ‘Well, those people are old anyway’ attitude,” she said, which discourages adequate government funding and public awareness. But older Americans are learning that “forgetfulness is not necessarily a part of getting older, and that there are things we can do about it,” she said.
But Smith does have a sense of humor about what she sometimes encounters in her profession. She and husband Sam, who is the director of an assisted living facility, have started writing a movie script that incorporates (anonymously, of course) some of their “very funny experiences working with people. ... I wish we had more time to work on it.”
The Smiths have two daughters, Marielle, 12, and Madeleine, 10, neither of whom seem to have an overt interest in medicine. “They are more interested in the building I work in than they are in my work,” Smith said. Three rescue dogs, Gumbo, Dixie LaRoux and Evangeline, round out the family’s home in Lutz.
Sam does almost all the cooking in the Smith household. “I make four things really well; otherwise, I stay out of the kitchen,” she said. But Smith does dabble in “arts and crafts stuff,” including looking for “treasures at flea markets” and making decorative home improvements. She also is on the board of directors for the Tampa Jewish Family Services, which runs a community food bank and provides counseling, financial assistance, senior services and other support to individuals and families of all faiths in Hillsborough County.
Smith confessed she is the “opposite of a role model in terms of diet and exercise. ... I hate exercising ... but I’m one of those people who can eat whatever I want and stay skinny. People hate me for that,” she laughed.
So, when she’s not working or parenting, that lifestyle fits right in with her favorite pastime. “I am remarkably lazy for a successful person. There is nowhere I'd rather be than home in my pajamas!”