House Call with Tobin Greensweig, MD
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Why are modern doctors feeling like strangers to their patients?
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In 2021, much of patient care takes place in the electronic chart. Doctors sit at computers placing orders and writing notes. And when we do meet patients face-to-face, it's often as strangers. What about the old days of medicine? Are house calls a thing of the past? You're listening to The Nocturnists, stories from the world of medicine. I'm Emily Silverman. Today, I talk to Tobin Greenswag. Tobin is a father, husband, and physician, currently practicing critical care in Seattle after several years of practice in Indianapolis. He went to medical school at Ben-Gurion University of the Negev in Israel and did a combined residency in internal medicine and pediatrics, followed by a fellowship in critical care at Indiana University.
Before we speak with Tobin, we'll hear the story he told at the Nocturnist in San Francisco in January 2020. Here's Tobin.
I was introduced to Carl over email. The email came from one of my co-fellows and it was a way of introducing me to the 15-odd patients whose care that I would be assuming in the intensive care unit the next day. The email went on to say that Carl was a 55-year-old man and he had severe COPD. He was on six to eight liters of home oxygen. He had heart failure, reduced ejection fraction, pulmonary hypertension, OSA, and a litany of other medical problems. Carl had called 911, and he did this because he couldn't breathe. By the time he got to the emergency department, he was blue. The emergency doctors immediately placed a breathing tube through his mouth, into his trachea, and connected him to a ventilator.
At that time, his PCO2 was 130. and his chest x-ray, it was ARDS, maybe multifocal pneumonia. Despite best medical treatment, antibiotics in the works, Carl didn't get better. We were now five or maybe seven days in. I don't think Carl's gonna make it out of the hospital. And if he does, that breathing tube in his mouth, I'm pretty sure it's gonna have to get moved, surgically implanted in his neck, a tracheostomy. Carl's family knew that something was in the works, and they had arranged for a goals of care update to happen tomorrow, my first day. I thought to myself, really? My first day, strangers? I have to tell them that Carl might die? I took out my checklist of things to do the next day, and I added a checkbox.
I also made sure there were some Tums in my backpack and got off to work the next day. Somehow, I just couldn't reconcile this medicine that I had signed myself up for with the medicine that I had grown up around. See, my dad is a family doctor, and when he finished residency, he joined the practice of Dr. Van Stein. Gertrude, as I knew her. Long after Gertrude retired, I would go to Gertrude's home, a ranch in Santa Rosa, and she would regale us with stories. These stories were very often about her cutting down trees with multiple chainsaws in the lower 40, and then subsequently burning out the clutch on her old Dodge pickup as she chained it to the back of the truck and attempted to pull these big stumps out.
But the real gems, the real golden nuggets, they were the stories of her medical practice. Gertrude took care of generations of families. She started in the OB room in the hospital. She continued in her clinic. Maybe when grandma got admitted to the hospital, she'd follow her there and then into the nursing home. And if necessary, Gertrude went right into the living room. House calls were the norm.
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