Source: www.ocregister.com/ocregister/ news/atoz/article_934357.php
The Morning Read: Bringing health home
Doctor takes a personal approach to patients, hauling his office to their living rooms.
This is not your typical doctor's office. The room is dim. The air reeks of stale cigarette smoke. When you sit on the sofa, a cloud of dust rises up. And the scale on the floor is 6 pounds off.
But today, for close to an hour, Bob Price's apartment in San Clemente is a doctor's office. Norm Vinn's office, to be precise.
You don't go to Vinn. Vinn comes to you. He is one of maybe a dozen physicians in Orange County whose business is making house calls.
While your family practitioner might squeeze in 20 to 30 patients a day, Vinn sees eight. While your family practitioner might see you for 15 to 30 minutes, Vinn listens for up to an hour.
"I don't want to get too weepy here," he says over a cup of steaming coffee at a booth at Denny's, his office this morning. But trading in his family practice for the slower-paced house-call track was a chance "to find some inner peace. And spiritual fulfillment."
He was sick of always being in "too much of a hurry to ask people about the book they're reading or their families," he says.
By 9 a.m. on most days, Vinn is finished surfing Lower Trestles and is driving to his first visit in his silver Lexus.
Today he stops on a street in San Clemente, fishes a stethoscope, doctor kit and miniature lab-test machine out of his trunk and walks up to the door of Apartment A with a knock and a holler. "Bob? It's Dr. Vinn!"
Inside, Bob Price is lying on his side in bed, his skinny legs barely covered by a loose blue hospital gown. There's no bottom sheet on the mattress. His feet are bare.
"No hair, no teeth, no aorta," is how Price sums up his condition. An aneurysm blew the aorta out and he's had prostate cancer for 11 years, not to mention "two bad hips and two bad legs," scoliosis, arthritis, a cold that won't quit, a rash, congestion and a creeping cataract.
But Price is an optimist. "Eighty-five and still alive!" he laughs.
Vinn "has been a godsend," Price says.
Price doesn't have a wife or children or a car, and even if he did own wheels he can barely hobble to the bathroom a few feet from his bed, let alone drive to a doctor.
He is the prototypical house-call patient. Medicare requires that it take "significant and taxing effort" for the patient to walk 100 feet before it will pay for a house call.
Vinn's patients include a young woman who was paralyzed in a freeway wreck and a man who can't get out of bed because he weighs more than 700 pounds. But most people he treats are in their 80s, trapped in their homes because their bodies are just calling it quits.
Just as often as Vinn discusses a patient's blood pressure, he finds himself discussing their mortality. Are they ready? How are they coping? "Candid, strange conversations," he says. If dementia is present, that conversation is often with the patient's spouse or children.
Because most of his patients are facing The End, the depression factor is one of the downsides of the house-call business. It brings to his mind the axiom: When you're a hammer, everything starts looking like a nail.
So when he starts feeling like everyone is dying, he takes off his red tie and white button-down shirt, puts on a wetsuit and heads to the ocean to put things back into perspective.
Vinn opened his practice in Long Beach in 1978 and enjoyed it until managed care came along in the '80s. The turnstile of patients, he said, became "very frustrating for patients and very frustrating for the doctors."
Vinn is an osteopathic physician, which means he treats the whole person. Besides diagnosing illnesses and treating symptoms, he counsels patients on nutrition and hygiene, addresses depression and loneliness, discusses financial hardships and even connects patients with social-service agencies.
In other words, he needs more than 20 minutes.
It got to a point where he was coming home at night to his wife and three daughters, "angry, irritable, frustrated, depressed. I wondered if I was a squirrel in a cage."
In 1998 Medicare began paying doctors more equitably to make house calls, Vinn says. The next year a colleague told Vinn about a doctor who had started a house-call business in San Diego. Vinn took a chance and joined the group. In 2002 he started his own business called Housecall Doctors Medical Group.
He brought in another doctor and three nurse practitioners and opened an office in Laguna Hills, but it's only used to store charts.
Not being chained to an office has its perks, but it also has a few hassles. Vinn puts 2,500 miles a month on his car driving to patients all over Orange County. He earns about 20 percent less than when he had an office practice. He meets medical officials in parking lots to sign death certificates and gets calls from patients at all hours.
The other night, a call came during dinner from a woman who got his number from a health-care agency. Vinn told her he was eating and would be there as soon as possible. By the time he showed up at her house, she said she was having her dinner and refused to let him in.
But most of the 350 patients in his practice are so appreciative, they practically gush.
Price says he is grateful that Vinn is simply around to talk to. And Price is quite a talker.
Now he is talking about how he never considered giving up smoking because he thinks it's therapeutic for people who experience depression. Vinn sticks a flu shot into Price's arm. Then he checks his prostate.
"Thank you, sir," Price says when it's done.
"Are you eating a lot? You look to me like your face is thinner," Vinn says.
"You think you can weigh me?" Price asks. "That's a good idea, doctor."
Price swings his legs around to sit on the bed. Then, leaning on his walker, he stands and steps precariously onto an old dusty scale that the doctor brought in from the kitchen. Letting go of his walker, Price balances for a few shaky seconds to put his full weight on the scale. It reads 127 pounds.
"I weighed 185!" Price says. "Well, stranger things have happened."
"Let's try it one more time," says the doctor.
The room is dim, maybe they read it wrong. "You want a flashlight?" Price asks.
Vinn says no but steps on the scale himself to check for accuracy. It's about 6 pounds light, he decides. When Price steps back on, it still registers 127. So he's probably 133 pounds, the doctor figures.
"Oh, man. If I had any sense, I'd be scared," Price says.
Six days later Price calls an ambulance to take him to a hospital in Long Beach. He can't manage his catheter anymore. Vinn gets wind of it, rings a San Clemente rest home and asks them to hold a bed for Price so he can bring him back to Orange County.
"That way Dr. Vinn can still look in on me," Price says. "Ya know. I think everything's gonna be fine."
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