Dale Hamrick's patients love his bedside banter, his no-nonsense style -- and the fact that he always comes to them
When Dale Hamrick pulls his red Toyota pickup into the driveway of a suburban home, he could be mistaken for a plumber or an electrician.
The backpack and running-style shoes he wears are misleading, too.
Then again, the pickup truck, backpack and shoes are surefire indications that this isn't your typical primary care physician.
The pickup truck is Hamrick's office. The backpack and a small mesh-and-leather bag hold his equipment -- laptop computer, stethoscope, thermometer, oxygen meter, blood-pressure cuff and otoscope, which helps him examine ears and noses.
The comfortable shoes? They fit the personality and style of a doctor whose entire practice is house calls and whose focus is on elderly patients, many of whom suffer from dementia or Parkinson's disease.
He comes to them, in their homes or at retirement homes. He jokes with them. He makes them feel better.
"They're relaxed because they're in their territory," said Hamrick, 59. "I don't wear a white jacket because that's too sterile. I want people to feel at home.
"I can learn more because they're not as afraid. They haven't been sitting in an office for an hour reading old Reader's Digests."
Hamrick's patients and their caregivers appreciate his willingness to come to them, and his attitude when he shows up.
"He is one in a million and not one bit of pretentiousness about him," said Jane Spangler-Boone, who cares for her elderly mother in her Lexington home. "He is a kind and gentle soul and so knowledgeable about those he treats."
NOTHING TRADITIONAL -- EXCEPT THE CARE
When he hears comments such as those, Hamrick makes self-deprecating jokes. He didn't become a doctor to boost his ego or his bank account. As with many others in his profession, his main goal is to help people live better lives. He just goes at it in a different way.
Dr. Tracy Robertson Voss in the internal medicine division at the USC School of Medicine has referred patients to Hamrick, usually when they have become homebound.
"He has bridged that time period near the end of life, keeping people in their homes," she said.
Health-care professionals often visit patients in their homes, but it's usually nurses or physical therapists. Voss doesn't know of any other physician in the Midlands whose practice is exclusively house calls.
Voss said she, like many other physicians, would have difficulty doing what Hamrick is doing.
"I don't have the gift Dale has," Voss said. "He can get stuck in a traffic jam on his way to seeing a patient and not get worried about it. If the lights go off in my office, I'd have a nervous breakdown. I'm type A, want everything to go according to schedule. He's type B."
Even if he were office-bound, Hamrick would be far from traditional. He was an economics major at the University of North Carolina and helped run a family pharmaceutical sales business in Shelby, N.C., until age 39. But when the family sold that business, he began looking for a new career.
"It was a struggle to figure out what I wanted to do when I grew up -- at 39," he explained.
A friend of his asked, "If you could just close your eyes and be something, what would you be?"
"A doctor," he said.
"Well just try," his friend replied.
Of course, you can't just close your eyes and wish yourself into medical school. So Hamrick called all six medical schools in the Carolinas.
The admissions office at the University of South Carolina Medical School offered the most encouragement.
"I'm going to put you on with my secretary for an appointment to come see me," said then-admissions director Robert Sabalis told Hamrick.
After that meeting, Hamrick spent two years in USC's undergraduate school, gaining the science credentials to get into medical school. Hamrick had flunked freshman chemistry at UNC, mainly from lack of interest, but he excelled in his second chance at college science courses.
After finishing medical school, he specialized in geriatrics during his residency at Wake Forest. Making house calls was part of the Wake Forest program. "It seemed like a great thing, better than the grind of a big practice," Hamrick said.
But he needed experience first, so he spent three years with private group practices in Spartanburg and Columbia. Then he took the giant leap and set out on his own.
He showed up at Parkinson's and dementia support groups to talk about his unusual practice, and word spread quickly. Family caregivers rejoiced that they wouldn't have to take elderly family members kicking and screaming to a doctors' office.
"I knew there was a demand because it worked well at Wake," he said. "Now I'm putting people off for weeks because I've got so much business."
As the practice grew, he contracted with a billing service. And he stays home on Wednesdays to catch up on paperwork. While his wife helps with some of the office chores, his practice basically is a solo effort.
The positive side is that he doesn't have to pay for nurses and office staff. The negative is that he doesn't have those staffers around to help. He does contract with a nurse to make female patients feel more comfortable on the rare times when they need to disrobe.
But on most days, it's just Hamrick, his truck, his backpack and his small bag of gear.
PATIENTS LIKE THE BEDSIDE BANTER
The Silbersacks love to see Hamrick stride up the sidewalk to their Lower Richland front door. He sees both Ray Silbersack, 84, and Millie Silbersack, 83, but most of his attention has been on Ray since his recent surgery for brain cancer.
Hamrick sits on the Silbersacks' comfortable brown sofa and sets his gear among the sea shells and plants on the coffee table as he checks Ray Silbersack's vital signs.
"OK, now breathe," Hamrick says. Then, after a few breaths, "OK, you can stop breathing now."
Ray Silbersack's look says he knows it doesn't make sense to contemplating stopping breathing altogether.
"I told you I was going to use all my old jokes today," Hamrick says.
As the doctor takes Ray Silbersack's pulse he complains about the patient's irregular heart beat.
"Would you quit saying I've got an irregular beat," says Ray Silbersack, who played drums in jazz groups until recently. "Can you imagine a drummer who has an irregular rhythm? Nobody's going to hire me."
They move to the bedroom so Ray Silbersack can stretch out on the bed for an EKG. Pads attached to wires tethered to a laptop computer provide details of his heart and lung efficiency.
"You're looking good," Hamrick says. "You're not good-looking, but you're looking good."
The banter is part of his bedside manner, especially in homes where the patients laugh uproariously, as Ray Silbersack does.
The Silbersacks' daughter heard about Hamrick's unusual practice and recommended him to her parents because her mother doesn't drive and her father shouldn't.
"We liked him almost immediately," Millie Silbersack says as Hamrick treats her husband. "He comes once a month when we're doing better, but he's been coming once a week since my husband's surgery.
"We used to go to Doctors Care, and you go in there and people are coughing and sneezing. You can catch all kinds of things, and you wait so long.
"With Dr. Hamrick, even if he's late, you're waiting in your own home."
As he walks back to his truck after spending about 45 minutes with the Silbersacks, Hamrick explains that many of his patients wouldn't go to a doctor's office for wellness visits. Instead, they would wait until they're extremely sick and end up in a hospital.
"It takes time for me to drive out here, but it's got to save Medicare money," says Hamrick, who files with Medicare or insurance companies for payment based on a set range of fees for procedures. "If doctors don't come to them, people wait until they're sick as dogs, and then they go to the emergency room."
DOCTOR IN BLUE JEANS FEELS LIKE A FRIEND
Patients with dementia or Parkinson's disease make up a large portion of Hamrick's practice. For many of them, a trip to a doctor's office isn't simply a hassle, it's a real trauma.
One of his dementia patients, Sammy Taylor, moved from the Upstate to a Lexington retirement community two years ago after his wife died. He needed full-time care, but the move took him away from his longtime doctor, according to his sister, Charlotte Miller.
"Sammy did not want to go to a doctor," Miller said. "He never liked doctors. But when Dr. Hamrick would come in wearing blue jeans and a backpack, Sammy thought this was his friend. Now he'll do anything for Dr. Hamrick."
On a recent visit, Hamrick asks Taylor about his career as a bank executive (Taylor has no recollection of that) and about the needlepoint art he creates. He mentions that Taylor won a prize for his needlepoint.
"You're famous," Hamrick says.
"That's a joke," Taylor responds.
Taylor is one of four patients Hamrick sees in the dementia section at this facility.
"I just talk like this with him and it tells me he's doing fine," Hamrick says. "He's happy. He's healthy."
UNIQUE PRACTICE HAS SOME DRAWBACKS
Not everything about Hamrick's situation is ideal.
Hamrick requires new patients to sign a contract, which makes it clear he's not on call 24 hours a day. If something serious comes up at night or on weekends, patients likely will need to go to a hospital emergency room or an emergency clinic.
As he felt his way along his unusual path, he also had to tell some patients he couldn't keep seeing them because they lived too far from any other patients. Medicare doesn't adjust its payments for longer trips.
If Medicare would pay more for house calls than office visits, maybe more doctors would leave their offices, Hamrick said. And that might have to happen as the population ages, with the accompanying rise in dementia.
Hamrick has butted heads with family members who disagreed with him on whether their elderly relative had dementia. And his jokes and straightforward manner aren't for everyone.
"I don't treat 'em like they're fragile and they're going to break," he said of his elderly patients. "That works real well for some people, but that turns some people off."
Some days, when he's driving to distant houses, he might see fewer than 10 patients. The daily case load goes up when he visits retirement communities. He's investigating new voice recognition software that might save him time writing down notes.
He could increase his income by spending less time with his patients, but he can't control his gift for gab.
"I love to talk," Hamrick said. "That's one of the fulfilling parts of being in people's homes. They feel comfortable talking to you."
Reach Holleman at (803) 771-8366.
In an audio slideshow by staff photographer Gerry Melendez, see and hear how Dr. Dale Hamrick makes his patients feel better. To see more of The State, or to subscribe to the newspaper, go to http://www.thestate.com. Copyright (c) 2009, The State, Columbia, S.C. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, The State, Columbia, S.C.