Through Making House Calls, Doctor Sees 'Underbelly Of Medicine'
ROBERT SIEGEL, HOST:
This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel. You've heard stories on this program about innovations in health care. Well, this is not one of them.
ERNEST BROWN: Hi, Dr. Brown. I want to just check on Pam.
SIEGEL: This is the opposite of innovation. It's a throwback.
BROWN: Ernest - Dr. Brown.
SIEGEL: We're about to meet a doctor who makes house calls. Now, if you were born in the last 50 years, you may not be familiar with the concept. A house call involves a physician bringing himself, his bag and his stethoscope to your home to examine you. It used to happen a lot. In the 1930s, about 40 percent of all doctor-patient interactions were in homes. These days, the average family physician conducts fewer-than-one house call per week. We are driving around Washington, D.C., with Dr. Ernest Brown. He wears blue hospital scrubs. Orange letters spell the words, house call doctor, custom embroidered on the back.
BROWN: I can do more out in the field than I could in clinic. The show is really all me. I take care of every facet.
SIEGEL: We detour around road construction. We wait at stop lights. It's not just that Dr. Brown does house calls. Dr. Brown only does house calls.
BROWN: You know, one of the problems when you work in the clinic is so much is coming in. You've got 10 minutes with a patient. You've got these results coming back. It gets so chaotic that you never really fully grasp that individual patient and what's going on with them. And I see the underbelly of medicine. I see where all the cracks - and I kind of am the guy who patches all the cracks as quickly as possible.
SIEGEL: He gets to see what kind of care his patients are getting at home. A lot of them are elderly and bed-ridden. Bedsores are a common problem. This was a house call at an apartment in Washington's Watergate complex.
BROWN: For the wounds that he has, the problem is providing the right type of mattress for him.
SIEGEL: On another floor of the Watergate complex, he comforts and elderly female patient.
BROWN: Good to see you.
UNIDENTIFIED WOMAN: Good to see you.
SIEGEL: She's clearly in the last months of her life, seated, looking out the window on a bright spring day.
BROWN: Are you in any pain now?
UNIDENTIFIED WOMAN: Yes.
BROWN: Where does it hurt - on your face? Right here? Do we have any Tylenol or anything we can crush and give to her?
SIEGEL: There he was talking to his patient's home caregiver. Ernest Brown is 47 years old, a graduate of Howard University College of Medicine. He says he likes the amount of time he spends with a patient. He says he makes house calls to two or three patients a day, sometimes a few more. Most doctors see about 19 patients per day. From downtown Washington, we head to a leafy middle-class neighborhood. The patient here is a 79-year-old Haitian American man, a retired musician.
BROWN: Does he take liquid, or it's just pure?
LYNNE THIESFELD: I've been using the liquid.
SIEGEL: His wife, Lynne Thiesfeld, knows Doctor Brown well.
BROWN: Is he starting to get more anxious now?
THIESFELD: Today he's very quiet. I don't know. Yesterday I think he was overactive.
SIEGEL: Ernest Brown does have a doctor's office of sorts. He says he's in it four to six hours a day - his car.
BROWN: Hi, Len. It's Ernest. How are you? Good, did you call?
SIEGEL: In his mobile office, Doctor Brown handles emergency calls, answers patients' questions, orders tests and prescriptions. The clogged roads of Washington, D.C., give him lots of time to see to this part of his work.
BROWN: I've literally driven almost every square inch of this city.
SIEGEL: We're across town now to see Odessa Harris, an 80-year-old retired civil servant who lives in the northeast section of the city. Mrs. Harris had been in the hospital because she wasn't eating.
BROWN: In the hospital, she actually just received some fluids and rebounded pretty well. But it was recommended by the hospital staff that she should really go into a rehab facility. And so she went to the rehab center, and the rehab center - the family would come every day and they would see that yeah, she got physical therapy one hour a day. And the rest of the time, she laid in bed.
SIEGEL: Odessa Harris's family stepped in and brought her home.
UNIDENTIFIED WOMAN: How are you?
BROWN: Good. How about you?
SIEGEL: Here she is still confined to bed, but it's her bed and instead of well-meaning strangers around her all day, she has the constant support of people she knows and loves.
BROWN: In order the - for the wound to fold in and heal itself...
SIEGEL: Mrs. Harris also suffers from bedsores.
BROWN: Apply the cream, it slowly dissolves it, and then the tissue can get together.
SIEGEL: There are four generations of her family under this roof. Quameice Harris is her granddaughter.
How many doctors have made house calls here in the past few years?
QUAMEICE HARRIS: Just Doctor Brown. She had a good primary care physician, but when she got to the point where we are now, it was too hard to maneuver her. You can't put her in a car without her moving all around. You have to hold her. It's kind of like having an infant without a car seat. So it became a really - a task just to take her to the doctors and make sure she was OK.
SIEGEL: And she has a hospital bed here?
HARRIS: She does. We pay for it out-of-pocket.
HARRIS: 'Cause it took too much to try to get her - her insurance said that we would have to pay a $1,500 deductible and then pay $400 a month to rent the bed.
SIEGEL: And Doctor Brown?
HARRIS: Doctor Brown is doing this out of the kindness of his heart.
SIEGEL: Ernest Brown doesn't charge the Harriss's. He says they're in the crack between being too well-off for Medicaid not well-enough-off to handle his fees. The fee-paying part of Doctor Brown's practice is literally concierge medicine. Several Washington hotels have his number, and the concierge calls when a guest needs medical attention.
SIEGEL: Is your relationship with the hotels now - is it formalized? Are you - do you have a retainer with the hotels?
BROWN: No, no, no.
SIEGEL: It's just by the call?
BROWN: It's just by the - I mean it's just like my other patients out there, anybody - word-of-mouth, you know, no advertising - really just know that I live in the community, and I'm there as a resource that - you know, if somebody needs help, I'm happy to help.
SIEGEL: For a fee of 300 to $400. Or if the call is after hours on weekends or holidays, it's more. Washington, D.C., has a constant flow of visitors, and Doctor Brown says he is called by foreign embassies, too, when a visitor needs medical attention. He says he has treated at least one defense minister and many diplomats. Brown does not deal with insurance. He leaves it to his patients to file for reimbursement, and he says it's a mistake to put a set price tag on what doctors do.
BROWN: Medicine or health care should not be a commodity. And when you try to commoditize healthcare, you're making a mistake because then it's not care.
SIEGEL: In his practice, Doctor Brown makes his own rules. No electronic records. His workday ends when his teenage son gets out of school. He doesn't charge military personnel or veterans anything. It's a career that may not work for all physicians, but it seems to work for him.
BROWN: What really drives me is waking up and getting out and seeing the city and seeing my patients.
SIEGEL: And that's what keeps him going. Brown says he wants to encourage more medical students to choose a career in house calls. Right now, according to the American Academy of Home Care Physicians, there are 4,000 physicians in addition to nurse practitioners and physician assistants who make home visits. One thing that's obvious from his clientele is that for frail, elderly patients, a trip to the doctor's office is a lot more complicated than a visit from the doctor. The aging of the baby-boom generation is stepping up demand for the house call.
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