My patients built me a practice

With lots of help from local volunteers, this doctor now runs a busy rural clinic. His ideas for patient involvement could work for you, too.

By Roshan A. Hussain, MD
Family Physician/Spencer, WV

It wasn't until I announced I was leaving town that my patients told me how much I was needed. They not only convinced me to stay; they helped set me up in a clinic of my own.

Because I had always dreamed of practicing in a poor, rural community, I was pleased when, in 1996, I was recruited by a federally funded, two-doctor family practice clinic in Spencer, WV. About an hour's drive northeast of Charleston, Spencer has no major industry, no big employers, and a population of 2,352.

Many of the residents are elderly or unemployed, and get by with the help of public assistance, food stamps, and subsistence farming. Some have no phone, television, or even indoor plumbing. Nearly 80 percent are on Medicare or Medicaid.

During my first few years in Spencer, I often made house calls to elderly patients and provided hospice care. I attended their funerals, and offered emotional support to their families. On weekends, I sometimes took my wife and two daughters along on house calls so they could appreciate how people here live.

As I got to know my patients and learned more about their culture, I realized that I have much in common with them. I was born and raised in Guyana, an underdeveloped country in South America. Like most boys in our village, I began working on my family's small farm by the age of 10. I still remember going to bed hungry and attending school in old clothes. The eldest of nine children, I'm the only one who attended high school.

I worked my way through college and medical school, spending several summers as a volunteer at primitive rural clinics in Guyana. I considered returning there after my residency to set up a clinic, but the economic and political obstacles were overwhelming.

So I went to work in Spencer, instead. There, I began to play an increasingly active role in the community and to grapple with psychosocial issues such as domestic violence and child abuse. I also helped organize a support group for cancer patients. Over three years as a clinic employee, however, I grew increasingly dissatisfied with the quality of the care and services there. I found it difficult to be part of a system in which patients were treated as though they were items on a conveyor belt.

A "goodbye" letter prompts an outpouring of support

I finally decided that I couldn't continue to practice with that group. But when I announced my impending departure in a "goodbye" letter in the local newspaper, I discovered how deep a bond I had formed with the community. While many of my patients knew of my dissatisfaction and weren't surprised by my decision, they didn't want me to leave.

Over the next few months, my patients held a series of meetings to discuss ways to keep me in the community. They located a vacant double-wide trailer that had once served as a satellite clinic for the group I worked with. Carpenters and other tradesmen volunteered to renovate the trailer's office and exam rooms. With money raised from donations, auctions, fund-raising dinners, and gospel concerts we bought medical equipment. Patients donated used computers, fax machines, copiers, and phones. Volunteers experienced with computers helped set up our office system.

With such enthusiastic support the trailer was ready in only three weeks, and the new Roane Community Health Clinic opened in March 2000. My full-time staff now consists of a registered nurse/medical assistant, and my wife, who serves as office manager. Volunteers handle front-desk tasks, answer phones, make appointments, and file charts. They also help indigent patients fill out forms to obtain free medication from the pharmaceutical companies.

Patient involvement improves public health

Every six months, we do satisfaction surveys with a random sample of patients. We then invite these patients to come to the office as a group to discuss their concerns and suggest how we can improve our care and services. Among the suggestions we've adopted: writing out instructions for elderly patients and having me call these patients' home health aides to discuss their care.

We give all patients appointment cards with my home phone and beeper numbers so that they can call me at any time. Fortunately, most are sensitive enough not to call during the night except for emergencies.

With volunteer support, I conduct several health fairs each year, focusing on preventive medicine: colorectal, prostate, and skin cancer screenings, osteoporosis, and pulmonary disease.

Based on the results of our survey of community needs, we applied for and received small grants from state and private sources for a weight-control project, cancer support groups, and hospice care. I'm actively involved in all those programs. We've also applied for federal nonprofit status so that we can seek grants from charitable foundations.

Our new clinic seems to be a success. Rather than the 25 to 30 patients a day I saw at my former clinic, I now see 15 to 25, which enables me to spend much more time with each one. The patients seem to appreciate the one-on-one attention. About half of them followed me here from my former group. A big reason for their support—and our success—is their direct involvement in our decision-making process. One measure of that involvement: on holidays and local festivals, patients bring in food, and help decorate the office.

A financial sacrifice pays off in other ways

My wife and I invested our personal savings to help get the clinic started. But we've since recouped most of that investment, and I feel it was money well spent. Still, launching the new clinic brought a sharp drop in income, and much longer hours. That first year, I put in 80-85 hours a week, while my salary dropped from $115,000 at my former group to about $50,000. My wife worked that first year without pay. Last year—our second—I could afford to increase my salary to $75,000 and to pay my wife a modest salary.

There's a clear need in Spencer and other poor communities for a physician who will make house calls and encourage people to take a more active role in their health care. I'm proud that I've been able to fulfill that role for my patients.

Practicing rural medicine is challenging, demanding, and time-consuming. It can test one's patience and tolerance, and put a heavy burden on family relationships. But for someone who's willing to become involved in and committed to community health, it can also be deeply rewarding and fulfilling.

 

Roshan Hussain. My patients built me a practice. Medical Economics 2002;7:123.