By Heather Sheedy -- Blue Mountain Eagle
(photo by the author)

JOHN DAY – It's not very often that you find a doctor who makes house calls, but Dr. David Graham is devoting two days per month to visiting patients housebound or residing at local nursing
homes and care facilities.

Because of the time and effort involved, this arrangement won't work for all patients, but for those unable or too sick to leave their homes, home visits have proved to be a valued service.

   Graham has included home visits as an organized part of his practice, and he's not the only one. In Grant County, doctors Bob Holland and Jack Jackson also make scheduled monthly nursing home visits, and Dr. Holland makes regular stops at the Canyon Creek Guest Home. All of Grant County's five family physicians make occasional home visits, mostly to elderly and infirm patients.
   For Graham, a typical day out of the office to see patients starts early and ends late. He'll put some miles on his Honda and usually spend from 30-45 minutes per patient. If he's visiting a patient for the first time in their own home, he could spend up to an hour and a half to better understand the variables that affect their treatment or recovery. Graham said that often a
home visit will uncover a missing piece of the puzzle that has been hindering effective improvement in a person's recovery.

   "I can learn more about a patient in 15 minutes at home than in 15 visits at the office," he said. He regularly conducts a safety evaluation of the home or is able to better understand an elderly person's shopping habits, nutrition or diet. Visiting with the supportive care givers also can be revealing.
   Blue Mountain Hospital District offers Home Health Care through three registered nurses, Richard Smarr, Erin Workman and director Jenelle Moulton. The nurses make scheduled home visits between the doctor's home visits, often visiting at least once a week. In addition, they are in close contact with the doctors to inform them of concerns, changes with the patient's condition or medication adjustments that may be needed. In general, they are the "eyes and ears in the field."
   The nurses call or stop by the office to discuss patients almost every day.

   "All Grant County doctors rely heavily on the home health nurses," said Graham. "Their care is the reason many people recover so well from a desperate illness, and their value to the county as a whole cannot be overestimated."

A variety of visits

   The home of Bob Boss of Canyon City was the first stop on Dr. Graham's home-visit list in late April. As the two sat down to talk, the non-stop discussion began. Each were aware that they had prepared mental lists of issues. The doctor opened the door for the dialogue with queries of:
"What are your concerns?" to "What are you doing to help yourself?" and "What can I do for you?". It was an honest exchange which began with communication issues – making sure the doctor receives messages and responds. Conversation moved to significant weight loss that resulted from a change in diet and fears about the possible progression of disease. It was evident, that Boss had been researching health-care issues and possible treatments that could be workable in his situation. Boss is one of the patients tended by R.N. Smarr between the doctor's visits. Boss commended Smarr for "going beyond the call of duty" to tend to his needs, including going
to the drug store to pick up prescriptions.

   Down the road, the doctor pulled up to the Canyon Creek Guest Home where he was greeted by Bobbi Murphey, a registered nurse and owner of the assisted-living facility. Before the patient visits began, Murphey was prepared for an in-depth consultation of Dr. Graham's patients' overall
health and many other variables that affect their well-being, such as family visits, current events in their lives, drug prescriptions including adjustments to medications, and test schedules or results.
   Four patients were on the agenda as Dr. Graham made his rounds. Attention was given to each – the doctor engaged in a cheery conversation with Roy Rasmussen, checked a patient's chin after a fall, gently woke a woman from a nap to see how things were going, and visited with a resident
about an attitude of "giving up." Medical professionals are aware that a person's mental attitude has an effect on their physical well-being, and naturally encouragement is given.

   From Murphey's standpoint, the visits by Dr.Graham, Dr. Holland and Dr. Russ Nichols are invaluable. They save people in her charge the sometimes tremendous effort it takes to go to the doctor's office.
   "The doctors get to know them better. So, if they are sent to the doctor's office or the hospital, the doctor has a better idea of how serious the problem," Murphey said because he's seen the patient's usual demeanor on a "good day." "Doctor visits at home are a lost art," and she'd like to see more of them for the elderly.
   By law, doctors who have patients in a registered nursing home are required to visit monthly in the beginning of the patient's stay, then twice a month as time progresses. Assisted living facilities do not have the same strict rules, but Dr. Graham finds it very efficient to visit monthly and keep abreast of all of his patients.

A trip to Mt. Vernon

   Next stop: Mary Mecham of Mt. Vernon. She first sought treatment for her diabetes about four years ago with various doctors. In December 1999 she saw Dr. Graham, and last winter he made a difficult care decision: She needed complete bed rest for her condition. She said his comment was: "I don't feel good about putting you to bed full time, then making you come to the office to see me." 
   A former teacher and school librarian, it has been difficult for Mary to stay down, but she said that Dr. Graham's visits have given her confidence and a good feeling that everything will be under control as long as she takes the needed steps to assist recovery. Between the doctor's visits, she is impressed with the home health care personnel, "busy people who make time" for
her, too.

   This was not the end of the day's rounds. Often the doctor's home visit day continues until evening, then there will be a stop at the office to check messages before he finally arrives home to his wife and young son.
   Making home visits is not financially lucrative for a doctor. In fact, Dr. Graham said it's "financially a dis-incentive," but it is "worth it" to him when patients can be more effectively treated. Home visits are not available for everyone, there are strict criteria set by Medicare and other insurance
providers – a patient must be homebound or it must be extremely difficult for him/her to get into the office to be seen.
   Dr. David Graham said home visits are "a part of caring for people we've lost." The personal touch is undeniably appreciated by the patients, who may take more active participation in their well-being.

   Graham knows he is in the minority when it comes to doctors making house calls, but has joined the American Academy of Home Care Physicians to share ideas with others. Additionally, he is preparing information for a textbook to be published this year that will encourage more family
practitioners to incorporate home visits into their regular office practices.
   There are no doubt many patients appreciative of the quality of health care now available in Grant County. Mary Mecham is one of those people. She said the arrival of younger new doctors is a"welcomed addition to our community." Of Dr. Graham's home visits, she said, "It means so much
to know that someone in the medical profession cares that much."

© 2002  Blue Mountain Eagle