Mark Hayward's City Matters: Doctor finds rewards treating the poor
May 15. 2013 9:13PM
What kind of health care do the poor deserve in Manchester?
A crowded emergency room?
An aspirin when the pain is slight, whiskey when it hurts more, a street-corner transaction when it's unbearable?
Perhaps they deserve physicals and checkups from one of the best doctors in the state.
That's what some 1,300 patients of Dr. Gavin Muir can count on. A family practitioner and the medical director of the Manchester Community Health Center, Muir was named family physician of the year last month by his colleagues.
The honor goes to a man who's spent his entire 15 years of doctoring in a street-level clinic in Manchester. Colleagues said he's turned down job offers that entail higher pay, shorter hours and less stress. Muir said he just enjoys what he's doing.
At the clinic, he said, he's more likely to treat a real disease, rather than a suburban-nurtured anxiety about a potential disease.
"I never (treated) the worried-well Caucasian population," said Muir, 43. He works at a clinic where seven physicians handle a caseload of 10,000 patients. About half their patients require an interpreter to talk to their doctor.
Each year, Muir and his colleagues see a handful of patients suffering from rare diseases such as tuberculosis or malaria.
They deliver babies of women scarred by the brutal custom of female circumcision. They have to convince patients not to rely solely on home remedies. They see patients who give priority to the grocery bill over expensive medication.
"My job is to know what these limitations are and offer them the highest quality care at the cheapest price," Muir said.
Yaritza Monis Vega brought her 2-year-old in for a checkup to Muir last week. "He respects his patients a lot," said Vega, who paid $15 for the visit.
Her friends encourage her to go to Dartmouth-Hitchcock or other physician practices. But she said the clinic offers a family atmosphere, and Muir is a patient, high-energy, happy person.
Igbal Mohamed, a physician assistant who shares a tiny office with Muir and two other providers, said she followed him as a student and returned to Manchester just because of him.
"He is my inspiration," she said. "He doesn't insult you about what you don't know. He teaches you. He loves to teach."
Muir earned his undergraduate degree from Princeton University and his medical degree from Temple University. He did his residency in southern Colorado, where he obviously picked up some Western state influences.
He sees patients in blue scrubs, not the de rigueur white lab coat of most docs. Birkenstock clogs and cotton socks cover his feet. His dark wavy hair is parted in the middle, and a trim beard circumscribes his cheekbone and chin.
When he's entering the results of the morning examinations into his computer, alternative rock pours from desktop speakers.
"He's just more laid back, really laid back," said his medical assistant, Cindy Hamel. "Nothing really bothers him."
Muir's bear-like size — 6 foot, 2 inches, 260 pounds — is offset by a voice a few decibels above the level of soft. He cocks his head when he speaks to patients and gestures. His assistants said he never tells a patient what to do.
In speaking to a first-time mom-to-be, he discusses the risks of natural childbirth — one out of three chance of bacteria in the birth canal; three out of 100 chance of pneumonia if the baby is exposed to the bacteria.
"He gave me the odds," said Chantelle Pelletier, a waitress whose pregnancy is covered by Medicaid. "He was thorough. Sometimes doctors don't address my concerns as attentively. He's aware of how I feel about things."
It would be nice to write that Muir's Colorado-mountain mystique has overcome the assembly-line medicine of our age.
But he has his busy schedule. His day is booked with back-to-back, 20-minute examinations. And the schedule can be thrown out of whack when Mohamed asks for help to treat a boil or Hamel schedules three diabetic patients — notoriously complicated cases for a physician — in a row, something akin to finals week for a high school senior.
"He doesn't really get mad. He gets antsy," Hamel said.
Five years ago, the clinic moved to a refurbished mill on Hollis Street. Its white walls and clean tile floors make it look modern.
But the hallways are small, and Muir's office would be mid-manager size, if he didn't have to share it with three others. (He would marvel at the luxury of my 25 square feet of desk and chair space.)
In his 15 years in Manchester, Muir said two actions — neither done by government — have improved access to health care for the poor and freed him up to doctor people. One is the acquisition of small-sized, speciality clinics by Elliot Hospital and Dartmouth-Hitchcock. That means Muir can refer a patient who needs a specialist to Elliot or Dartmouth, which both accept clinic patients. No need to call specialists and convince them to take on a patient who can't pay.
The second is the $4 generic prescriptions offered by Walmart, Hannaford and other big-box stores. No need to scramble for prescription samples or coupons.
As for Obamacare, Muir's biggest worry is there won't be enough physicians or nurses available to treat the influx of patients.
Yet, even if his caseload grows, it's doubtful Muir will go anywhere.
He came to Manchester for three reasons, he said. The government paid off 80 percent of his college loan because the job involved serving the poor. The White Mountains are nearby. And unlike other medical practices, the Manchester clinic eschews the use of specialists to deliver babies.
In fact, Muir turned down an offer to be a family physician for the Elliot system because it wouldn't involve delivery. He said delivering babies is a great way to keep his patient mix young. And most of the time, two healthy patients leave the hospital.
"The obstetrics piece," Muir said, "is the highlight of my job."
Mark Hayward's City Matters appears Thursdays in the New Hampshire Union Leader and UnionLeader.com. He can be reached at firstname.lastname@example.org.