Medical Tuesday Blog
Country doctors have gone the way of the dodo bird. But occasionally one surfaces. A number of doctors in my community have made house calls. However, they are getting more infrequent. The takeover of medical practices by the government, insurance carriers, bureaucracies and technology have precipitated the change. However, there are segments of our society where it is still practiced in a variation of the traditional form. Physicians had to become more selective on whom we made a visit. My visits were to patients who would be unable to come to my office. What follows is refreshing and familiar story from yesteryear.
Bob Greene interviews a Country Doctor Who Can’t Forget His 40 Years of House Calls in the WSJ on Feb 9, 2018
Dr. Kemper, now retired, is 98 years old. He lives in northern Wisconsin, in the town of Chippewa Falls, population 14,000, where he was a single-practice family physician for more than 40 years, from the 1940s into the 1980s.
We were talking about house calls. I wanted to speak with him because, with all the current controversy about health care—the fate of the Affordable Care Act; the recent proposal by business-and-financial titans Jeff Bezos, Warren Buffett and Jamie Dimon to upend the economics of medicine; the machinations of the big insurance companies—we sometimes forget that the so-called health-care industry was not always, to America’s families, a confusing and intimidating behemoth. Health care was life-size: a doctor you knew, a doctor who would drive his car to your house if you said you needed him.
“It was never a nuisance,” Dr. Kemper said. The number of doctors who remember when house calls were common is shrinking fast; Dr. Kemper told me that, for him, it was not a once-in-a-while thing, but a basic part of his medical practice. When his patients were very sick, he went to them instead of asking them to get out of bed and come to him. “You could tell in a glance, when you arrived at a home, how serious the situation was,” he said. “And then my attitude was: time to get to work. Let’s get you the help you need.”
He is dismissive of the term “health-care provider”: “I saw myself as a country doctor,” he said. He is mightily impressed by the technology available to physicians today, the myriad medical specialties and advances. He knows that the days of routine house calls are never coming back.
But when the phone by his bed would ring in the middle of a cold Wisconsin night, there was no feeling like it: “If someone was calling at 3 a.m., I didn’t have to ask them if it was an emergency. They wouldn’t be calling me if it wasn’t. I was out of bed and out of the house within 10 minutes. I didn’t waste time asking if they thought it could wait until morning. Of course it couldn’t. They needed me there, and they needed me now.”
The reward? “Every day, still, when I’m walking around town, people come up to me,” he said. “They thank me. They say, ‘You delivered all of our children, and now I’m a great-grandparent.’ There were so many patients over the years that, I have to admit, sometimes I don’t recognize them. But they will thank me, and I’ll say, ‘You’re looking good,’ and I don’t know if they realize that they are making my day.”
Today, our house calls are not for emergencies. We could be sued for malpractice for delaying the facilities of a hospital emergency room. Our house calls today are for people disabled but still able to live in their home with the help of a spouse or family member. In a pulmonary practice, the disability is usually extreme shortness of breath to the point of hypoxia requiring oxygen on a continuous basis. This is frequently the result of COPD or emphysema. But the rewards that Dr. Kemper speaks of above are still the same. Having given up my office practice in 2015 because the risks far exceeded the rewards, I was very pleased to receive a phone call from the wife of a patient in March of last year that I had treated for 16 years. She stated that her husband was dying, and he would like to see me to say thank you for being his doctor for these 16 years. The first 8 he came to my office. When his lung failure became severe in 2008 from the additional pneumonia, he required 8 liters of oxygen per minute. Initially he could walk past his front door on a 50 ft oxygen line. But as he became weaker, he no longer could see me back to my car.
When I came by, I sat beside him on his bed. As we talked, I examined his extremities and his joints were all pliable. But he scarcely had any muscles left. His wife said he’s lost about 50 pounds. I chided him on not using his muscles. Maybe we should work on rehabbing him. He seemed interested. I told him if he wanted to live and become stronger, I would come by every few weeks and go through the range of motion for each joint and muscle strengthening maneuvers as long as he wanted to live. Since, I was no longer in practice, it would all be at no charge. (I guess attorneys call this pro bono.)
On my return the next week, he seemed more cheerful, and showed me he could raise his arms and legs. Before I returned the next week, his wife called me and said that he had died while she was taking a break in her bed. She cried because she was not holding him in her arms as he died.
Like Dr. Kemper told Bob Greene, the rewards continued after the practice. The reward from this patient and his wife exceeds all the remunerative rewards of a practice. It’s these precious rewards that are also disappearing in today’s medical practice. They can’t come in a totally regimented practice.
Our research arm, HealthPlanUSA, which had to be abandoned during the late Obama years, still feels there is a possible solution. The answers, however, will not come from the insurance industry or the government. We will be resuming this program with new people with interest in private, personalized, patient centered health care. http://www.healthplanusa.net/newsletter-archives/
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