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In the fictitious world of TV medicine, doctors Welby, House, McDreamy and Spaceman among them have all the time in the world to spend with patients. But we patients know that medicine is often a high speed, impersonal, insurance-driven industry. Dr. Lesley Fernow sees things from a patient's point of view. She rejected the possibility that the art of practicing medicine was becoming as irrelevant as a vestigial organ, and she did something about it.
In 2008 she shuttered her solo internal medicine practice and began seeing her mostly elderly patients in their homes. "Medicine is becoming more difficult to practice in a mindful, patient-centered way," says Dr. Fernow. She explains that stresses on office physicians include "pressure to see more patients faster," as well as "billing and compliance management and quality performance measurement, which takes attention from listening." All that endless paperwork and documentation, she says, increase physicians' distance from their patients. And for Dr. Fernow, they led to a decrease in the pleasure she took in her work.
Dr. Fernow lives in Maine with her husband. But every two weeks she travels seven hours to Connecticut, along with an assistant who does the driving, to see her mostly elderly and homebound patients.
House calls let Dr. Fernow practice what she refers to as "patient-centered" care. Treating patients in their homes allows her to see her the "whole picture." In learning firsthand the home situation, "Family interactions, dietary restrictions and life lived now and in the past," she's able to glean a more comprehensive and holistic picture of their lives. And she's able to spend as much time as she needs with each patient. This, she says, as opposed to the 10 or 12 minutes of time a doctor typically spends with a patient in an office setting.
She explains her life is enriched by family photos on the mantle or by a patient's paintings on the wall, as well as by the courage and openness people are able to express when they're in their own home. "I regained my soul in this practice," she says.
Among the challenges Dr. Fernow faces is using her medical skills with her mostly homebound patients for whom it is virtually impossible to pop over to a local hospital for diagnostic tests. But she finds her logistically complicated practice gratifying personally and professionally. Sitting in a patient's home and learning who they are is invaluable, she says.
Dr. Fernow believes the anachronistic house call can be a model for the care of housebound patients. The awareness she gains with each encounter, she says,"Makes it easier to connect with each patient on a human level." That connection, says Dr. Fernow, is an essential part of healing.
When was the last time you received a housecall from your doctor? Let me know.
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