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Editorial Archives — The Altamont Enterprise, March 20, 2008


Just what the doctor ordered

 When I was a child, I loved my doctor, Frank De Rook. He had come from the Netherlands and practiced medicine with his wife from their family’s home on Fletcher Road in Guilderland.

He and his wife, Jane De Rook, could be reached easily by phone. If you were sick, you never had to wait long to see them.

Dr. De Rook knew me, really knew me. He knew my sisters and my parents and my grandmother. He treated us all. He was gentle and jovial, a philosopher as well as a physician. When I got older, I could discuss topics with him ranging from the poetry of Emily Dickinson to favorite hikes in the Adirondacks.

He knew me as a person, not just a collection of ailments.

When I left town to go to college and later to university for graduate work, I stopped seeing him. In my adult life, I have seen many doctors — at school clinics, in a large practice of obstetricians or allergists, in ever-shifting group practices. I have been tended to by many qualified professionals, but I have never had the peace of mind I had as a patient of Dr. De Rook. I’ve not felt like there was a person caring for me who knew me.

I am not alone.

More than half of Americans haven’t seen the same doctor for more than five years and studies have shown the importance of continuity for healing.

Medicine is big business. Eighty percent of Americans take some kind of pill every week. And, in the last decade, Americans have increased their consumption of medication by 50 percent.

In the 1950s, when I was growing up, each American, on average, spent $500, in current dollars, for health care annually; that figure has now increased ten-fold — to $5,000 per person.

A lot of people are frustrated with waiting weeks or months to see doctors, particularly specialists, and are also upset with 10- or 15-minute exchanges with doctors they hardly know — and this after long sessions in the waiting room.

It turns out, some doctors are frustrated with the system as well.

Dr. L. Gordon Moore, a family doctor from a Rochester suburb, was so frustrated with practicing in a large group — he said he felt like he was on a treadmill — that he pioneered a new approach he calls a micro practice. Moore started in 2001 with no staff. Instead, he  answered the phone himself and used computers to handle such tasks as keeping patient records and making appointments — all instantly accessible.

He leads the Ideal Micro Practice Project, part of the Ideal Medical Practices initiative that says it is committed to “real-world, real-time improvement of clinical office practice” that is financially viable; truly patient-centered; highly efficient, effective, and accessible; and sustainable.

Moore, for example, has said that he was able to make 30 percent more money seeing a dozen patients a day in his micro practice than he earned when he worked in a large practice, seeing up to 30 patients a day. The reason? Sixty to 70 percent of the revenues in a traditional practice go to pay overhead, largely for staff.

Doctors with micro practices, and their numbers are growing, leave over half their slots open each day to be filled as patients need them, and they typically spend a half-hour or more with each patient.

The Ideal Medical Home website stresses the importance of a patient and doctor “being on the same page,” indicating that it takes time and trust to build a productive relationship.

Patients most often don’t follow a doctor’s advice, it says, because they are not “on the same page.”

It goes on, “Our health behaviors may contribute to about 50 percent of early deaths and a lot of illness. People still smoke despite its huge impact on health; obesity is increasing everywhere; sexually transmitted diseases increase; the list goes on!”

One woman is about to make a difference in our Hilltown community. Dr. Myria Emeny will occupy the Westerlo office once run by the revered Dr. Anna Perkins. Perkins practiced the sort of medicine that valued knowing the whole person, not just treating an ailment in a regimented time-constrained office setting. She made house calls, even if it meant putting on snowshoes to get there. She knew entire families and the all-important relationships that bound them.

When she died in 1993, she bequeathed her Westerlo home and medical office to continue serving the community. The Anna W. Perkins Helderberg Health Center was run as a charity clinic by St. Peter’s Hospital since shortly after her death, until this year. St. Peter’s was losing patients and money, and so closed the clinic, leaving many in the rural community feeling stranded.

Emeny says she’ll have much in common with Perkins — handling her own calls, being part of the community, “not a doctor who travels in and leaves.”

“I feel micro practice is committed to the patient rather than the doctor’s convenience — finding that collaborative care,” Emeny told our reporter, Tyler Schuling.

She also said, “I’m looking to provide long-term care. I think that medicine needs to be not only an office visit, but a healing relationship.”

Emeny spoke of the joys of caring for generations of the same family. If a patient comes in with a headache, she said, and you know there’s just been a death in the family, rather than looking immediately into a neurological cause, said Emeny, “You start treating the pain, but you also treat the emotional pain because you know the whole family.”

These are qualities Perkins, and physicians of an earlier generation, brought to their practice.

But as a micro practitioner, Emeny will add a modern dimension.

Patients will book appointments — with half her slots open each day — by computer, and all of her medical records will be electronic.

“When you call me on the phone, I’m going to have your record in front of me,” she said. “Then I’ll know exactly what you’re on. I’ll know exactly how to help you over the phone.” Emeny will be able to advise patients over the phone — such as diabetics who have changed their insulin levels — every few days, rather than having them constantly into the office.

She says she’ll have her phone on 24/7.

How can Emeny succeed where a large and wealthy institution like St. Peter’s failed?  “Their numbers were dwindling in terms of their goal — 25 patients per day,” she said. Because the clinic had a full-time nurse and secretary, it needed bigger numbers to pay for overhead, she said. “They were only getting 11 to 15. My goal is no more than 12 per day.”

We admire her pluck and embrace her philosophy. We hope Dr. Emeny succeeds and has the support of the community, and we hope other doctors will consider the approach.

As more doctors enter lucrative specialties, there are fewer general practitioners, especially in rural areas.  With medicine as it now stands, said Emeny, doctors are  “on a hamster wheel.”

“They’re talking about cutting visits from 15 minutes to 10 because the overhead continues to climb,” she said.

That’s not satisfying for the doctor, and not healing for the patient.

I may never again be able to say I love my doctor, the way I did Dr. De Rook in my childhood, but wouldn’t it be wonderful to say I know my doctor and my doctor knows me?

Melissa Hale-Spencer


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