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Monday, July 6, 2009

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Have the doctor come to you By SHAVAUGHN MOSS ~ Lifestyles Editor ~ shavaughn@nasguard.com: With age, everyone slows down. And we all know relatives who as they get older, become difficult to deal with because they become plain ole' miserable, or are afflicted with an ailment which does not allow them to move about as easily as they would like to, which in turn makes them "crotchety." And woe unto the person who has to get that cantankerous relative, dressed and out of the house for a regular doctor's appointment, when they really don't want to go anywhere, because it's just too much trouble. That can turn out to be a "day from hell." Estella Whylly, 76, isn't one of those difficult relatives, but she does suffer from hypertension and diabetes, has to visit the doctor on a regular basis, and is confined to a wheelchair, so she is not as mobile as she could be. Because of her situation, she has to depend on her children, Sharon and Andrew, to ensure that she makes her twice-monthly appointments. Her son drops her off, and she is picked up by her daughter so that she can get back home. To ensure that Estella does not spend all day at the hospital, she has to leave her Carmichael Road home on doctor visit day by 6 a.m. to get an early number at the government hospital, so that she could try returning home by 12 noon. This situation has worked well for the Whyllys over the years, but, the doctor coming to them would be even better. Andrew could sleep in later, and Sharon wouldn't have to battle lunch time traffic to take her mother home. The brother and sister also wouldn't have to worry about how their mother is fending for herself, while on her own. Sharon says her mother frequently has tales after of someone helping to push her somewhere, but says it would be good for her mother if she could avoid all of that. It was seeing the difficulties that patients like Whylly encountered that "tugged" at the heart strings of internal medicine specialist Dr. Latonia J. Moncur and prompted her to start "House Calls", a service where she goes to the patient, and provides private primary care service to the sick adult patient in the comfort and privacy of their own home. "It wasn't any one particular patient that made me decide to do [house calls]," says Dr. Moncur. "It is just trying to fill a need, and that's what I was thinking about when I thought of this. Seeing people who are wheelchair-bound trying to seek medical care having to sit and wait to be seen by a physician, kind of 'pulls a chord' in your heart. There are people for whom it's painful to come to see the doctor . . . they have arthritis, or other skeletal problems that cause pain when they walk — you see these people in a regular clinic setting, and you feel it in your heart. These are the people that I felt a need to provide service to," she said. Dr. Moncur's service is mainly geared towards the bed-bound, the home-bound, the debilitated, the frail, elderly or adult patient who is unable to seek medical care in a regular setting, and are unable to walk into a doctor's office. She does not treat emergencies. It's a service Sharon would welcome for her mother, and she says her mother would appreciate. "A lot of times she complains because she's tired, and she would say 'boy if I really didn't have to go,' . . . and a few times she canceled [her appointment] because she was really tired, but it wouldn't have happened if the doctor had been able to go to her," she said. For most Bahamians a doctor making a house call to check on a sick patient is unheard of, and images of the physician walking with his black bag to deliver care to his patient usually comes from a movie or a book with pictures. But Dr. Moncur says she's not unique and that there are a number of physicians who actually still make house calls — which was the way doctors operated in an era when there were little or no testing instruments, and physicians relied mainly on their cognitive skills. According to the internist, it was after World War II, and many medical changes that made house calls by medical professionals less popular — the introduction of anesthesia and other drugs, development of vaccinations and x-ray, use of ultra-sound, and the discovery of DNA to name a few. "The new techniques and procedures and modern technology were available only in the clinics and hospitals, and assisted physicians in helping to make a diagnosis. The quality of care required by modern standards associated with modern standards required a higher degree of objective testing to confirm a physician's clinical opinion. Coupled with the development of the third party tier — insurance companies and other liability concerns, the way medicine was delivered before was affected. The patient going to the doctor's office, rather than the doctor going to the patient's home, allowed the physician to provide care to a larger number of people. House calls by medical professionals became less popular," she said. With her service, she says she has found that quite a number of people are surprised to find that she makes house calls. But she says she is not the only doctor doing so, and that there are still some doctors providing this type of service in The Bahamas, but that many people just don't know about it. Dr. Moncur says she's found that home visits are not only more convenient for patients, but is also less stressful for them. Home visits she says also affords her the opportunity to observe how patients live, and to focus on things she would not be able to during an office visit — seeing whether a patient is still smoking, or whether a patient may need more mobility aid in the home, or their furniture rearranged to prevent falls, or for them to get around. "I'm able to notice things that patients may not admit to you when they're in a doctor's office, because they feel more relaxed. Patients, usually the elderly tend to forget their medications at home when they go to the doctor's office, or forget to mention the over the counter medications that they are also taking," she said. A typical physician/patient encounter at home would include Dr. Moncur getting a medical history and doing a complete examination, an assessment of the patient's surroundings, and monitoring of their nutritional status. She also has access to private laboratory services to coordinate phlebotomy, if she needs labs, and coordinates with private nursing services, if she identifies that there is a need for nursing assistance in the home. The internal medicine specialist says witnessing the trials of patients like Whylly and knowing that there are many people with limited mobility who are chronically home-bound or bed-bound due to physical disability, and others with dementia who may get agitated in an office setting or that kind of environment which urged her to start making house calls. For the Whyllys, finances plays an important party in why the matriarch of the family goes to the government medical facility, but for those patients who attend a private physician, Dr. Moncur says the cost for a home visit by her is comparable to going into an office to see an internal medical specialist. She does allow for transportation allowance, according to where the patient lives. And when she arrives on your doorstep — rain or shine — if an appointment is booked, Dr. Moncur may or may not be wearing her white doctor's coat, that depends on how hot it is on the day, and the stethoscope isn't slung around her neck — it's her bag, which is red, not black. She identifies herself and greets her patients with a smile to put them at ease and let them know that she is there to provide good medical care to them in the comfort of their home. In countries like Canada, France and Britain, house calls by doctors are still popular. Monday, July 6, 2009