Doctor favors house call diagnosis ANNE ARUNDEL HEALTH

October 06, 1992|By Deidre Nerreau McCabe | Deidre Nerreau McCabe,Staff Writer

Paul Rhodes is a 43-year-old bachelor who wears black cowboy boots, drives a beat-up, 1977 Alfa Romeo with 170,000 miles on it and says he isn't interested in the usual trappings that come with being a doctor.

He even makes house calls.

In fact, Dr. Rhodes and his colleagues travel as much as 500 miles in a week to visit elderly, often frail patients from Baltimore to Northern Virginia.

Dr. Rhodes created Geriatric Care of the Baltimore/Washington Area six years ago to provide medical care to elderly patients who are house-bound.

He acknowledges that his pet project may not be the most efficient way to deliver health care. But, he added, many of the practice's 200-plus patients would not see a doctor regularly if not for Geriatric Care, which is why he keeps it going, though it continues to lose money.

"They need me," he explained. "I believe in this project."

On Friday, Dr. Rhodes finished his regular patient load at the Crofton Medical Group at 1:30 p.m. Grabbing a folder two inches thick, he headed out the back door to his Alfa Romeo.

His next patient was 83-year-old Charles Henson, a massive man with a breathing tube extended from his nose, leaning back in a brown velvet reclining chair in a tiny cottage off Sunrise Beach Road in Crownsville.

After an enthusiastic greeting, Dr. Rhodes wanted to know more about his patient. Who lives with the man and who visits? How often do the grandchildren and great grandchildren come over? Do the great-grandchildren climb up into his lap?

How often does he get a shave? Once or twice a week? Is that enough? Does he like after-shave? What brand? The doctor wanted to know.

During the examination, Dr. Rhodes covered basic exercises for Mr. Henson, adjusted his medication and created a chart for relatives caring for him, suggesting care tips for each day.

He told Mr. Henson and his adult grandson that he believed Mr. Henson was depressed, and he wanted the family to cheer him up.

Leaving the house, he explained his philosophy for caring for the elderly.

"For an elderly patient, who has experienced so many losses, these little things can be very important," he said. "What we want to do is restore what we can."

Home visits are crucial to the health of many elderly, he said, not only because many patients cannot get to the doctor easily but because doctors notice things during a house call that would not be apparent in an office visit.

At Mr. Henson's home, for example, he noticed that medicine bottles were not clearly marked and suggested that the family be more careful.

"This is dangerous. You could make a mistake," he said.

Dr. S. Blaise Chromiak, who makes house calls for the practice three days a week, agreed visiting patients in their homes can make a big difference in the quality of care.

"It's a special thing, a house call," he said. "We do more than examine the patient. We evaluate the environment. There's a lot that goes into it."

The one drawback for Geriatric Care's services might be the cost -- about $175 per visit. Medicare only covers $50 for the actual examination. The patients are charged for the rest to cover doctors' travel time and costs, administrative fees, consultations and phone bills.

Although the cost may be prohibitive for some, it is significantly less than the cost of hiring a private ambulance to get to a doctor's office.

Walter Kulchechy, 72, of Odenton, said that's exactly what he had to do before moving to Maryland from Virginia last year and discovering Geriatric Care.

Mr. Kulchechy, who lives with his daughter and son-in-law, said the house call practice has saved him money and made life easier.

"It was quite complicated before. I tried and tried to find a doctor who would do house calls, but couldn't," he said.

The practice also continues to see some patients who can't VTC afford the fees, Dr. Rhodes said, although not as many as before. "We were just losing too much money," he explained.

Geriatric Care doctors now see 10 to 20 patients a week, Dr. Rhodes said. He hopes to increase that to at least 20 a week so the business breaks even, he said.

"Would I like a return on my investment?" he asked. "Sure. But to make a house call to a frail elderly person, who could be depressed, who can't move, that's important. I feel stronger caring for them. . . . It's the most important thing in my life."

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