POCKET-SIZE MEDICINE
By Christine Gorman
Dr. Gresham Bayne practices medicine in some pretty unusual places. Just last month the San Diego physician was worshipping at the Point Loma Community Presbyterian Church when a fellow parishioner collapsed in her pew. Rather than call 911 to rush the 96-year-old woman to the hospital, Bayne asked the ushers to take her to the church parlor. The doctor, who is something of a gadget freak, was equipped for any contingency. Stashed in his black bag--actually a blue-and-gray fishing-tackle box--was a miniaturized version of every diagnostic tool he needed to assess her symptoms, as well as a full supply of standard emergency-care drugs to treat them. "You've got to stop thinking about bricks and mortar," Bayne says. "Today I am the emergency room."
Welcome to pocket-size medicine. The revolution in microelectronics that gave us cellular phones and palmtop computers now allows doctors like Bayne to take their healing arts out of the hospital and onto the road. The result: fully functional EKG machines no bigger than a box of chocolates; blood-sample analyzers no larger than a princess phone; portable ultrasound machines that fit in the trunk of a car. There is even a hand-held mri scanner in the works that is about the size and shape of a catcher's mitt. And last week the U.S. Food and Drug Administration approved a paperback-size automatic defibrillator that can shock a stopped heart back into a normal rhythm.
Bayne took full advantage of the new technology that Sunday morning in Point Loma. Although he could not feel a pulse at his patient's wrist, he was able to determine that it had fallen from a normal 80 beats a minute to 38 by placing a digital pulse monitor the size of a lemon on the woman's finger. He then touched her chest with a portable EKG machine and analyzed her cardiac rhythms. Had there been any indication that she was suffering a heart attack, Bayne would immediately have called 911. When he determined that wasn't the case, he decided to perform a battery of blood tests.
No sooner said than done: from the woman's wrist the doctor drew a sample, injected it into a tiny cassette and snapped it into a hand-held blood analyzer. Within two minutes, all readings came up normal. There was no sign of dehydration, anemia, insulin shock or kidney failure. "In a standard emergency room, it would have taken me 30 minutes to an hour to get those test results," Bayne says.
Questioning his patient, Bayne finally deduced that a prescription drug she was taking had caused her heart to slow, decreasing the flow of oxygen to her brain and sending her into a faint. That settled, he administered a stimulant called atropine to strengthen her heartbeat. Total elapsed time from pew to recovery: eight minutes, just about as long as it would have taken to get her to the emergency room in an ambulance.
It would be impractical, of course, to put a doctor in every church--or even on every street corner. But Bayne has an answer for that. He is one of the founders of the Call Doc Medical Group, five well-equipped physicians and three technicians who work through a central dispatcher to bring their high-tech tools to elderly, homebound and disabled patients. San Diegoans can just pick up the phone and dial 1-800-call-doc to patch through to one of the group's physicians. If the symptoms are not so dire that they require a call to 911, one of Call Doc's physicians can be on the scene within a few hours. Average cost per call is $150, which compares quite favorably to a typical $350 charge for an ambulance and anywhere from $1,000 to $3,000 for a visit to the emergency room.
Call Doc is not the only doctors' group taking advantage of the new flexibility the miniature equipment affords them. Similar associations are forming in Tampa, Florida, and Palm Springs, California. Patients appreciate the service, and the physicians seem to enjoy providing it. "Now that I can make house calls," says Bayne, "I feel like a doctor again."