Oberta Jurgensen sits in her wheelchair in the living room of the house she has lived in for over 50 years. The mid-day sun shines through the front window making the white lights on her Christmas tree hard to see, but it accentuates the sparkle in her eyes; the glow of her smile. However, ninety-three years of life have taken its toll on her body, with the past few months being perhaps the hardest.
She suffers from long list of ailments: Congestive heart failure, severe osteoporosis, high blood pressure, a respiratory ailment called COPD which is similar to emphysema, and constriction of the esophagus which prevents her from swallowing, thus the feeding tube below her colorful night gown. When she speaks her voice sounds like it’s emanating from underwater, but this doesn’t prevent the stories from flowing. She tells of how she and her father took the “work train” from Alberene to Schuyler, Virginia, so she could pick up here graduation certificate; how her sister “died right there in the church pew on Father’s Day,” and how at 15 she gave her sick mother three doses of pure apple brandy a day which was prescribed by a country doctor and supplied by a local moon shiner.
Over the past few weeks, she’s been telling her stories to a welcome and much needed visitor considering her medical condition; a bright, kind-hearted, forty-two year old doctor by the name of Dr. John Patterson. It’s safe to say that Dr. Patterson is a rarity in the field of medical care because he still makes house calls.
According to the New England Journal of Medicine, 40 percent of all doctor–patient visits in the 1930’s were house calls. By 1980, that number declined to less than one percent. And as the home care business grew in the 1990’s the number of house calls by doctors continued to drop. To the best of his knowledge, he is the only doctor in Virginia Beach who brings his practice to the people. Most of the patients he visits live in Pungo, but a few live along Shore Drive, in Thalia, and near the resort area.
Oberta’s granddaughter and primary care giver Kimberly Garnes thinks “it’s wonderful to have Dr. Patterson come out and see her. She couldn’t have stood being dragged back and forth to a doctor any more because it’s just too stressful. It makes her blood pressure too high.” Getting elderly who are infirm and often bed bound into a doctors office is one of the many challenges families and primary care givers face.
“It’s really sad,” explains Dr. Patterson. “There are people I see now who have not seen a doctor in years because they couldn’t get out and see one. They end up having an illness that puts them in bed and unless the patient can physically see the doctor they can’t get the care they need. It’s very frustrating.”
It was frustration with the high volume, high-stress nature of corporate medical practices that led Dr. Patterson down the path – or, in this case the occasional dirt road – of becoming a country doctor. “Many doctors are getting disillusioned with the regular office practice and with the process,’ says Dr. Patterson. “Big offices are about volume and lose the personal touch.”
He has experienced both sides of the fence. Before going into practice for himself in June of 2002, he spent eight years with a large practice where he saw on average 30 for 40 patients a day while at the same time seeing his income drop by 40%. Today, he gets to spend more quality time with his patients which number between eight and ten a day.
All in all, Dr Patterson takes care of about 500 patients compared to upwards of 2000 for a doctor in a typical practice. Of that 500, roughly 100 are home-bound patients like Oberta. Half of his time is spent with these patients, the majority of which are in their 80s and 90s and suffer from a variety of ailments like Parkinson’s, high blood pressure, heart problems, and dementia. Medicare insurance pays for most of the services associated with a house call, and the balance is covered by other insurance plans the patient may have. For Medicare, there is a separate fee schedule for home visits which takes into account for time and travel.
“There are a lot of advantages to making a house call,’ explains Dr. Patterson. “Family medicine is knowing as much about the person as you can. You get a whole different level of insight by going into their homes. You see how people interact with them; how they are cared for emotionally and physically; and the cleanliness of the place.”
Susan Vierra, a veteran nurse of over 30 years is extremely grateful that Dr. Patterson entered their home and their lives and credits him for saving the life of her 89 year old father who suffered a stroke back in May. “I’m sure my father would not be here today if weren’t for Dr. Patterson taking the time and effort, and believing he can make a difference. And he made a big difference. Some people were ready to write my father off after his stroke, not Dr. Patterson. She refers to him as “one of a kind” (which he probably is) and commends him for his “intelligence, his bed side manner, and for being such a compassionate human being.”
While she’s happy her father is alive and doing well, she is extremely frustrated with entire Medicare system. She has to fight tooth and nail to get a hospital bed covered by Medicare despite the fact she is saving the system thousands of dollars by taking care of him at home. She’s quick to point out that Dr. Patterson also has to “jump through a lot of hoops to get paid for the service he provides.” When Dr. Patterson is not making house calls, he sees patients in his house in Pungo which sits on 75 acres. A narrow gravel road slices through the trees and leads to small wooden bridge that extends over a moat-like body of water in front of the home. A late model, brown Jeep Liberty is parked out front. The license plate reads: “CNTRY MD.”
The spacious front room, which would be normally reserved for the living room is a his combination examination room and office. While most practices spend thousands of dollars to make their offices look homey and inviting, Dr. Patterson’s place is that way naturally. There’s a large portrait of his wife taken in high school on one wall. Book shelves are lined with everything from children’s books, to medical books to a book about basset hounds, of which Dr. Patterson has four. A skeleton stands quietly in the corner.
“This is the kind of set up I grew up with in Philly,” explains Dr. Patterson. “Our family doctor at the time operated out of his basement and made house calls. Now, everyone is so enamored with this type of arrangement.” However, running a doctors office out of a home has its advantages and disadvantages.
On the upside, he’s able to spend quality time with patients and keep his overhead down because he doesn’t have to support a big office. On the down side, it’s just him. What’s more, the medical climate has been somewhat tumultuous over the past five years. “What you are paid is fixed,” explains Dr. Patterson. “It’s decided by Medicare and the pay out hasn’t increased much over the years. On the other hand, fees are skyrocketing and the only way you can make it a traditional practice is more volume. I survive because I have no overhead.” Case in point: In just three short years, Dr. Patterson’s malpractice insurance has gone up ten fold, from $1700 the first year to $18,000. Dr. Patterson thinks that many doctors could wind up doing what he’s doing or just leaving the field of medicine.
Dr. Patterson believes the advantages outweigh the disadvantages. “The fun thing about this, he explains, is there’s nothing complex or technical about it. Most of the time it’s me and the patient. It’s simple and straightforward”
Spending quality time with the patients has resulted in close relationships and a few unexpected perks. Over the years, he has received fresh eggs, fruit, baked bread, and pies from his patients. The real satisfaction for him comes from knowing that he his making a real difference in the lives of others, building a successful practice and simply doing what he loves to do.
Oberta Jurgensen offers up sage advice that apparently Dr. Patterson is following. “You make your life like you want it to be. If you want to live a happy life, you can be happy. A lot of people don’t realize that. Ain’t that right?”
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