His office every Monday afternoon is his no-frills red minivan, strewed
with map books because he's prone to getting lost. Into the back seat are
tossed files for the patients of the day. Onto the front seat is heaved his
zippered black bag. The shoulder-strap medicine cabinet is filled with
syringes, bandages and ample doses of homespun wisdom. Back when "doctors were
doctors," as Henry Wieman says, not much else was needed. Maybe that's still
the case.
Each time his van leaves the Fort Lincoln Family Medical
Center on Bladensburg Road in Prince George's County, Wieman is the slightly
rumpled personification of a beloved American institution: the doctor's house
call. It was declared dead awhile back, prematurely it seems. For in the age of
impersonal, high-tech medicine, the house call is coming back. Its revival is
partly a backlash against that technology. But the demands of a rapidly aging
population are the stronger force. Elderly people whose frailties essentially
confine them to bed cannot come into the office for appointments -- at least
not without complicated arrangements for wheelchair vans or ambulances, as well
as physical and emotional trauma.
"You simply can't take care of an
elderly or chronically ill person without being able to make house calls," says
John Burton, director of the geriatric medicine division at Johns Hopkins
University Medical School. The school requires undergraduates and training
residents to spend up to two years doing home visits. "It's a very powerful
learning arena." According to the American Academy of Home Care Physicians,
slightly less than 5 percent of the country's doctors regularly make house
calls. Several hundred, though, do nothing but that, and, increasingly, others
may follow.
With a healthy bump last year in the amount Medicare pays
doctors for traveling to patients, preliminary statistics indicate that house
calls jumped 25 percent in 1998. Before 1998, notes academy President George
Taler, nurses were reimbursed more than physicians for visiting a person's
home. As the new director of long-term care at Washington Hospital Center,
Taler soon will launch a house-call service geared primarily toward older
people. "The information you get from scanning their environment can tell you a
great deal," he says. Social and economic issues surface more readily at home.
People behave differently -- and confide more.
This decidedly
back-to-the-future approach fits Hank Wieman well. A family practitioner turned
geriatrician, he's given to sayings such as, "It's not the mileage, it's the
tread wear," which pithily sums up his attitude about age. He regards his
elderly patients as fascinating living history and finds them as likable as
they seem to find him. "They always think you're young," he laughs. He is
52.
Although connected to the geriatric group at the District's
Providence Hospital, Wieman works out of the small strip shopping center where
the Fort Lincoln clinic is located. A wall map there is pierced with 36 pins
marking his house call stops, mainly in Prince George's and Northeast
Washington. He rotates through several people each Monday, spending up to an
hour with each. Some home-care physicians carry portable diagnostic equipment
that rivals that in any office. Wieman does not even have a cell
phone.
Two weeks before Walter Gordon turns 100, Wieman knocks again on
the door of his D.C. row house. Gordon's wife (a week from 90) greets him
warmly, and with her and a daughter following, the doctor hikes up to a
second-floor bedroom. Wieman sits where he can in the small room, which is on
the bed. His patient, wearing navy-striped pajamas and an expressive,
totem-pole face, sits silently in a corner recliner. Bed and recliner -- the
two landmarks of a declining man's shrinking world. Gordon no longer can walk
down the stairs, which no longer have a railing. This will have to do. Daddy
fell again yesterday, says his daughter, wedged himself between his chair and
the dresser as he tried to stand up. Plus, she adds, his stomach won't hold
food much, so he's still not really eating.
Wieman takes it all in as he
assesses Gordon's strength, gauges whether his depression is any better, talks
baseball briefly, delivers a mild lecture about how best to eat and writes a
prescription to settle the stomach. And then, before he goes, this contemporary
Marcus Welby gets down on a knee and trims his patient's toenails.