Summit doctor brings back the home visit

By Lory Pounder
http://www.summitdaily.com

BRECKENRIDGE — Instead of going to the emergency room after ripping the side of his leg open while riding rails in the park, the uninsured snowboarder decided to duct tape it together.

About 10 days later, he heard about Dr. David Gray and gave him a call. “He’d done a pretty good job,� said the Summit County doctor who practices house call emergency medicine.

Three weeks later, the snowboarder tore it back open, and this time, he headed to Gray’s home where the doctor stitched his leg up on the kitchen table and charged him $75. It would have cost in the thousands if he went to the ER, Gray said about the familiar place.

Thirty-three years ago, a hospital emergency room in Texas is where he began his career. At that time, patient information was handwritten on a single page. Now, a stack of paperwork that doesn’t help with care accompanies the patient, Gray said.

“I watched the evolution of the practice,� he continued.

And while Gray isn’t the only one in the medical field disappointed by changes in the last couple decades surrounding insurance, litigation and more, he escaped those issues by founding High Altitude Mobile Physicians in Summit County.

“I rediscovered the joy of medicine,â€? he said. “It’s feels good to be able to help people. … I’m getting as much as I’ve giving. It’s fun again.â€?

From Corpus Christi to Breckenridge

Eight years ago, Gray and his family — Wife, Denise, children, Joshua, 18, Kayla, 15, Dylan, 13 — moved to Breckenridge, and the board-certified emergency medicine doctor opened his 24/7 practice that has seen such success he may be looking for help soon. Before that, he was chief of staff at a hospital in Corpus Christi, Texas, and he still works as the medical director for several rural ambulance services across South Texas, setting protocols, standards.

He was familiar with Summit County from numerous ski trips, and while here on vacation, an advertisement with a horse and buggy caught his eye. It belonged to a doctor doing house calls in Vail. Intrigued, Gray called the doctor to learn about the practice.

Then, after returning home, he had an epiphany. It was in the moment he watched a nurse tell a patient she couldn’t give out any information over the phone and they would need to come in for treatment. It upset him because about 60 percent of what Gray saw in the ER could have been handled competently over the phone, he said.

“But the legal atmosphere doesn’t allow that. … I didn’t go into medicine for that. I went into it to help people,â€? Gray said.

So, he called the doctor in Vail and set up an agreement about the area they would each cover. The change reminded him why he went to Rush University in Chicago and chose emergency medicine, which was just becoming a specialty at the time.

“I’ll take care of anything,� said Gray who loves the immediacy of diagnosis, treatment and acting quickly to save lives. As an ER doctor, “you’ve seen and dealt with everything and some things you can’t even imagine.�

Another side of medicine

For Gray, insurance and litigation sucked the joy out of medicine for him. Now, he doesn’t deal with insurance. Instead, he deals with the patient. If they want to submit a claim to insurance, he provides a receipt and code.

Concerning litigation, he watched meritless claims of malpractice skyrocket, citing a personal example of when he was sued for an incident that occurred with another doctor while he was home sleeping. And according to various sources, there is a high cost associated with meritless claims — something that sparked a bit of debate in the last few years.

In fact, according to findings by the American Medical Student Association, 79 percent of physicians claimed they had ordered more tests than necessary to avoid litigation. Additionally, 41 percent claimed they had prescribed unnecessary medications for the same reason, and 76 percent of physicians were concerned that malpractice hurts their ability to give quality care, the association reported.

“There would be a more rational use of resources if you didn’t fear a system where you get accused of negligence,� Gray said.

For example, if someone goes to an emergency room coughing, they may get an X-ray or CAT scan to make sure the doctor doesn’t miss the possibility that they have lung cancer, he said. But if they just waited a few days to see if the cough cleared, that would save the patient a lot of money, he added.

The solution the medical student association offered included broad reform targeting litigation, insurance and health care systems. According to the Insurance Information Institute, the cost of medical malpractice insurance began to rise at the beginning of this decade. The institute quotes a study saying that since medical malpractice insurance data was first separated out from other types of insurance, it outpaced other tort areas, rising an average of 11.7 percent a year compared with 9 percent for other areas.

However, a The New England Journal of Medicine study in 2006 concluded that while claims lacking evidence of error are not uncommon, most are denied compensation. Overall, the study found that claims not involving errors accounted for 13 to 16 percent of the system’s total monetary costs.

Still, Gray witnessed a direct impact. While working in Corpus Christi, he watched as five of the seven neurosurgeons left the area due to litigation, he said, adding that the need for their service was still there.

“A lot of people don’t understand that side of medicine,� he said.

From past to present

So, while the thought of a home doctor may evoke images from the past of a man in a long dark coat with a black bag extending from his hand as he bounds up steps to a front door, it’s only in more recent history that that picture nearly vanished.

According to a National Public Radio article, “House calls were the norm for physicians until the end of the 19th century, when the rise of hospitals and health insurance and improved transportation led to a shift to the office-based practice. By 1971, only 1 percent of U.S. doctors were making home visits to patients.�

Another source cited the move to more specialist-intensive care for the change.
Yet, from 2000 to 2006, the numbers of house calls paid by Medicare rose from 1.5 million to 2 million, according to the American Academy of Home Care Physicians.

However, they are still far fewer than office visits, and most often, the calls are for the terminally ill or homebound.

Visitors often tell Gray, who also speaks Spanish fluently, they would love to have a service like his where they live, but “this is a bit of a niche� because of the resort atmosphere, he said. He did, however, help another doctor set up this kind of practice in Tennessee.

And Gray did indeed start with a black doctors’ bag, but it wasn’t big enough. Now he carries a larger red bag equipped with instruments, alcohol swabs, medication and even urine tests. He can treat 80 percent of what he needs from the bag. If there is something else he needs, he grabs it from his home office before heading out, he said.

“If you go into the ER, you’re likely to be there for several hours. … I can treat and diagnose within 45 minutes,â€? he added.

Often, Gray makes calls to the hotels where visitors experience altitude sickness, but he is no stranger among the local population either.

“I can take care of them in the hardware store. I can take care of them here,� said Gray during an interview at his home. “When people call and I answer the phone they’re like, ‘This is the doctor?’ They aren’t used to it.�

Lory Pounder can be reached at (970) 668-4628, or at lpounder@summitdaily.com.

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