It's fun to go to work again

April 22, 2005

Tired of practice hassles, the author opened a nonprofit clinic and rediscovered the joy of medicine.

That fateful day three years ago began quietly enough, but soon every other phone call seemed to demand my attention.

"Dr. Stuart, line two," announced my receptionist. "The drugstore says Mr. Edwards' medication isn't covered by his formulary." A few minutes later: "Dr. Stuart, line three. The HMO says they're coming for a chart audit on Wednesday." Still pondering this last piece of news, I heard, "Dr. Stuart, line one. The insurance company doesn't like the code you used for Mrs. P's checkup."

And so it went all day-a day not unlike so many others I'd experienced in recent years. Why was so much of my time being taken by nonphysicians telling me how to do my job? After 22 years in family medicine, I longed to be left alone to practice the craft I loved.

Roughly one in seven Americans had no insurance at all. Included in this growing group were young people just out of college; single parents working several part-time jobs; and those who had access to insurance but simply couldn't afford the monthly premiums, which often surpassed their monthly mortgage payments.

Where did all these people go when they became ill? There was the local hospital ED, of course, but that option could leave them with a huge unpaid bill. If they lived near a medical school, they could go to the outpatient clinic there, but that might mean seeing a different intern each time they went. Or they could simply forego treatment altogether, risking a longer time out of work or something more dire if their conditioned worsened.

I vowed to do whatever little I could about this inequality of care. Perhaps this was the way to change my practice situation, and do something worthwhile at the same time.

As it happened, I knew an Episcopal priest, the Rev. Marie Swayze, whose parish property included a former rectory. Now boarded up and dilapidated, this once-beautiful Victorian mansion had sustained such water damage over the years that the third-floor bedrooms and second-floor ceiling had nearly been destroyed. Nourished by the leaking slate roof, a forest of moss and leaves had taken root on the second floor.

As my friend Rev. Swayze and I contemplated the old rectory, an idea struck us: Why not turn it into a clinic-a place that would welcome all uninsured patients, whatever their income level or geographical location? Against all reason, we vowed to transform the mansion, which we leased from the church for $1 a year, into a place that anyone would be glad to enter.

Using my diagnostic skill again-and loving it To realize our dream, we raised more than $400,000 from private donors, churches, and corporations. With part of this money, we hired a contractor to work out our plans. He built exam rooms, which we painted in various pastel hues; refurbished the mansion's original woodwork; and installed tall windows, which filled the house with golden sunshine. For the spring, we decided on a lovely garden, full of flowers and shrubs.

To staff the clinic, we turned to a friend, a former office manager of a large Maryland practice, who located people who were willing to volunteer their clerical skills. Nurses in our community heard about us, and they were also eager to volunteer their time.

In October 2002, we opened the clinic's refurbished doors to the public.

That first day we saw only five patients, but what a joy it was to care for them. One was a 45-year-old man who'd had impacted cerumen for years. Following treatment, he could once again hear. As he left, he smiled broadly, handing us a $10 contribution.

The next day, a few more patients came in to see us, including a mother who brought a child with severe asthma. After treating the child, we gave the mother a nebulizer and medications to prevent her daughter from relapsing.

As the days went on, more and more patients came in. Before long, I was working harder than at any time in my life, but loving every minute of it.