Older Doctors Learn New Tricks
By Phil Barber
Feb. 12, 2001 (San Mateo, Calif.) -- Floriberto sits on the edge of an exam table, wearing a zippered gray sweatshirt, jeans, sandals, an immaculately crisp Raiders cap, and a look of unrelenting pain. His right cheek bulges noticeably.
A day laborer from Mexico, he has a severely infected tooth. "I tried to find help," he says through an interpreter. "I went door to door for a doctor, but no one would help."
Finally, his sister suggested the right door: Samaritan House Clinic. He will be examined here, in a low-slung, nondescript building in San Mateo, because he meets the clinic's three prerequisites. He is indigent, has no health insurance, and lives within the geographical boundaries of Millbrae and San Carlos -- prospering suburbs between San Francisco and Silicon Valley.
"Most communities have this population of invisible people," says William Schwartz, MD, a retired internist who co-founded the clinic in 1992. "You see these elegant Hillsborough addresses on the forms, but they're not paying the mortgage. They're living in a room over the garage."
About two-thirds of the clinic's patients speak Spanish, though many other languages and cultures are represented. These are men and women who work as nannies, gardeners, and dishwashers, living as many as five to a room to keep up with the Bay Area's steep rents. Some are here legally; others are not. (Samaritan House makes no distinction.) Most have treatable medical problems such as diabetes, high blood pressure, or tuberculosis that become emergencies if not caught early.
Floriberto needs immediate attention. Schwartz will refer him to an outside dentist, for services not available at Samaritan House. The patient will return to the clinic a week later for a prescription of antibiotics and will receive ongoing dental care there for weeks.
Samaritan House Clinic certainly isn't the only place in America that dispenses free health care, but its structure could make it a model for other communities. The clinic has a rotating staff of 25 to 30 doctors, plus at least 15 registered nurses, 12 clerks, and 15 interpreters. Yet only three positions are paid, and one of them is half time. The rest are volunteers, and most of them are retired.
Or, we should say, they are not still working full time for pay. "I don't like to say 'retired,'" says Schwartz. "I prefer to talk about the 'transition phase.' Well, this phase could be one-third of a doctor's life. We're talking about people with a tremendous amount to offer."
The clinic is an offshoot of Samaritan House, a nonprofit organization that provides food, clothing, and other social services to the needy. The clinic began as a one-room, one-night-a-week operation with two doctors and one nurse. When it moved into new space in 1996, Schwartz encountered a problem. "Lo and behold, our volunteers couldn't work in the day," he says. "They had jobs."
Out of necessity came an innovative strategy. Schwartz contacted retired doctors and found that many had been looking for just such an opportunity. Samaritan House Clinic now books 500 to 600 appointments a month, divided among weekday afternoons and Monday evenings, and specialty clinics on weekday mornings. The clinic's reputation has flourished to such an extent that it has more doctors than it needs, including specialists in gynecology, dentistry, neurology, and dermatology.
Not that Schwartz has given up recruiting. When Jerrold Kaplan, MD, a 61-year-old internist, decided to retire from his regular practice in January 2000, Schwartz was on him like a starched lab coat. "Within two days of telling my partners, Bill was on the line," Kaplan says. "I hadn't even written a letter to my patients."
Kaplan was equally eager to work out an arrangement with Schwartz, for the same reason most doctors prize their involvement with Samaritan House. After feeling the increasingly uncomfortable crush of managed care, they look forward to practicing medicine the way they learned it. "This is one of the last bastions where old-fashioned medicine is still being practiced in the Bay Area," says Elliot Shubin, MD, formerly the acting medical director, and current president of the San Mateo County Medical Association. "Doctors are inspired when they find out it's not all assembly-line, impersonal, high-tech medicine. There are huge benefits to face-to-face communication. It reminds us why we went into medicine."
Samaritan House Clinic intentionally books more physicians than it needs every day, allowing the retired doctors, many in their 70s and working a half day a week, to take a day off when they want one. Just as important, it creates an unhurried and personable atmosphere. It is not uncommon for Samaritan House doctors to spend 30 to 60 minutes talking to a single patient. "A lot of patients have psychosocial issues," says Karla Petersen, a fourth-year medical student at UC-San Francisco who drew the clinic as a rotational internship and subsequently fell in love with it. "It's easy to just come in and look at their charts, and not think about their jobs, their families, and all those things. "It's easy to forget to ask, 'How are you?'"
Now Petersen is learning -- thanks to a group of doctors old enough to remember when that was standard medical practice.
Phil Barber is a writer based in Calistoga, Calif.
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