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This article originally appeared in Town Topics, the weekly community newspaper of Princeton, NJ, on July 16 2014.
Compassionate Personalized Medical Care, Including House Calls, From Pamela Barton, MD
Individuals of a certain age may remember when the doctor actually came to the house. Perhaps to treat a child’s ear ache or stomach ache, a dad’s bronchitis, a mom’s bursitis, or a grandparent’s heart condition.
Indeed, once upon a time, such house calls were commonplace. Over time, however, with increased reliance on advances in technology and sophisticated medical equipment, office visits became the norm.
House calls are very rare today, but Princeton-based Dr. Pamela Barton believes strongly in the value of seeing the patient in the home environment. “What I learn from being in the home and treating the whole person and the whole family is really huge. I see the patient and the family as a unit, and I think about the whole picture. It’s important to watch and listen, and hear what the patient and family have to say.
“I have an on-going relationship with every single person involved with the care of the patient — family members, friends, care-givers — everyone. I talk with every specialist who treats the patient. I want to know that the patient is well-cared for in every way.”
“And, I am a generalist,” Dr. Barton continues. “As such, I am very comfortable consulting a specialist. I can serve as a mediator between the family members and other physicians, when necessary. The important thing is for people to have the information and understand it. It’s very important that the patient and family are aware of the implications of the disease, and understand about the medication.”
A graduate of New York Medical College in Valhalla, N.Y., Dr. Barton is board-certified in hospice and palliative medicine. She took her residency at Hunterdon Medical Center in Flemington, specializing in family medicine.
In 1999, she opened her own practice, Princeton Primary Care, in Princeton, with an office on Ewing Street. She notes that “I had always liked Princeton, and I wanted to practice here.”
Three years later, she took temporary leave to devote needed time to family and children, and then in 2006, reopened the practice, but with a different emphasis. “I decided to focus on house calls. It fit into my schedule and made sense for my family life. I see adult patients of all ages and in all types of medical conditions. They can be people with terminal diagnoses or individuals who are basically well, but prefer to have the doctor come to the house. I may just see the latter for a once-a-year check-up, or if they have the flu or some other illness. I really see a spectrum of patients and illnesses.”
She explains that she provides comprehensive medical care to patients with difficult diagnoses, such as Alzheimer’s Disease and other forms of dementia, congestive heart failure, emphysema, hypertension, chronic kidney disease, diabetes mellitus, coronary and valvular heart disease, ALS (Lou Gehrig’s Disease), cancers and leukemias, stroke, Parkinson’s Disease, arthritis, pneumonia, urinary tract infections, stroke, and delirium, among other afflictions.
“I basically treat people at home, but if they are acutely ill, and I feel that they need to go to the hospital, I will arrange that. I’ll call ER, and if they are admitted, I’ll stay in touch with the attending physician.”
Dr. Barton explains that a great number of medical conditions can be treated at home. For example, X-ray and ultra sound equipment can be brought to the house. “Blood can be drawn, blood pressure, lungs, and heart can also be checked at the home,” notes Dr. Barton. “I basically have my office in my bag!”
Although her patients do cover a wide spectrum. Dr. Barton has a special affinity and empathy for “the frail elderly, the medically fragile, and patients at the end of life.” The majority, but not all, of these seriously ill individuals, who may be receiving palliative or hospice care, are older.
“Palliative care is oriented toward comfort,” explains Dr. Barton. “Actually, all doctors really practice palliative care. It’s basically about having comfort — from the right pillow to the right medication. It’s providing care and compassion. And palliative care is unique in that with it, we treat the family along side the patient, and partner with the family. The concept of palliative care is really becoming more intrinsic to modern medicine.”
With her focus on house calls, Dr. Barton experiences the gamut of human nature, she reports. “What I love most about my job is that I get to see people caring for each other. For seriously ill or end-of-life patients to have the support of family and friends, as part of a loving group who care about them, care for them, and come to see them, means so much.
“Often, for an end-of-life patient, each day is so important. They want peace of mind; they want to know that their individual life has meaning. ‘What is the meaning of my being here?’ ‘What is the meaning of my life?’ It’s existential. They want to know if they lived a good life. Did they help people?”
Dr. Barton certainly witnesses the mysteries of life and death in her practice. And she explains that sometimes, solutions can be unexpected. “For example, I had an end-of-life patient who continued to experience severe pain although she was receiving proper amounts of medication. In this case, the patient’s pain was finally alleviated when she was able to concentrate on her life and what had been most important to her. Who and what had mattered in her life? She had especially loved flowers and traveling. So I helped her write down some of these thoughts, and the pain lessened dramatically.”
“It was really a different type of will, something special, a part of herself that she could leave to others. In one case, such thoughts were eventually posted on a Facebook page.”
Dr. Barton often sees both patients and families come through difficult situations that they might have felt unable to handle. “Sometimes, it’s practical life problems,” she explains. “Figuring out how to find a solution and making something work, even by getting a more comfortable pillow or different chair for a patient. Other times, people rise to the occasion in unusual ways. There was a case of a divorced couple, and when the ex-husband became terminally ill, his former wife came to take care of him, and was so resourceful in responding to his needs.
“I think that my goal is not just to fix something, but to be part of the process,” she continues. “I think of my job as helping people cope with whatever comes their way; helping them deal with the terrible afflictions that can come to them, whether they are physical or mental problems. Sometimes, cognition is intact, but the body is breaking down. Or it can be the reverse. By making house calls, I am coming into their home environment to help them through this.”
Dr. Barton typically spends an hour with a patient, and if an individual is on hospice, she will see them once a week or more.
“I am an organizer,” she adds. “I’ll help arrange for hospice if there is a terminal diagnosis for a patient. I can arrange for the visiting nurse and health aides to come, and I stay in touch with them. I frequently make charts to help care-givers keep track of the patient’s symptoms, medications, sleeping habits, appetite, etc. Also, sometimes the patient’s family is not nearby, but they need to know that their loved one has the best care. I try to be accessible to the family and patient at any time.”
Dr. Barton is licensed in New Jersey and New York, and divides her practice between Princeton and Manhattan. She does not take insurance, but can make special payment arrangements depending on individual patient circumstances and needs.
She is dedicated to continuing her work, exclusively focusing on house calls, and doing her best for each patient. “For me, every situation is totally different. Every patient is different. I look forward to educating patients and their families. I’ll be making videos and posting them on my website, exploring different topics, such as palliative care, pain management, care-giving, delirium, etc. — a whole range of issues. Most especially, I want to support the patient, their family and friends, and their care-givers, helping to bring peace to painful situations.”