Pediatrician in Anacostia: One of a Handful Works to Keep Children Healthy
Come at 10:00 a.m., the doctor says, and we can talk, because the first patient is not formally scheduled until 11:00.
It’s only 10:15 and there are already three mothers with five children in the waiting room, and the three examining rooms are occupied.
Dr. Robert Dickey somehow manages to look both harried and calm. It is normal morning in his Anacostia office.
It is bad enough being an adult in need of medical attention in Southeast Washington where there are 6.900 persons for every physician. The federal government calls an area medically underserved if there is fewer than one doctor for every 3,500 persons.
But for the 87,000 children and teenagers east of the Anacostia River, things are even worse, for there are fewer than a dozen private pediatricians serving that entire sector of Washington, while the District on a city-wide basis has more doctors than its needs.
Dickey is one of a handful of pediatricians caring for the children of Anacostia. He cares for 2,800 of them, more than some of the city’s public clinics.
But Dickey’s office in the basement of the Marbury Plaza apartments at 2300 Good Hope Road SE is anything but a clinic. Dickey functions more as an old-fashioned small town doctor using modern methods of practice to care for up to 230 children in a single week.
Margie Jackson took her 4-year-old daughter, Terri, to Dickey last Thursday morning “because she has a terrible cold.” Terri has been a patient of Dickey since her birth, when the Jackson family lived on Naylor Road SE. Two years ago, the family moved to suburban Camp Springs, a 20-minute drive from the doctors office. “But I’ll always keep coming,” Jackson said.
“I like the way he explains things, how he takes his time, how he examines each one. He’s always patient and she’s never afraid,” said the mother, gesturing toward her runny-nosed daughter. “If it’s an emergency he takes you right away.
“I called him last night at one o’clock,” she continued. “She had a fever, an earache and a terrible cold. He told me to get some olive oil and heat it, feel it with my wrist and put it in her ear and it would stop the hurting. And it did.
“I had the older one” - a 16-year-old daughter - “here and he spent an hour talking to her,” Jackson said. “He has a lot of patience and lot of time. No matter how many patients he has he doesn’t rush at all.”
Dickey knows all his patients, for unlike some physicians in inner city areas, he doesn’t run what amounts to a private emergency room.
“We’re pretty strict with people,” he says. “We tell them that we’re not an emergency room. We’ll only see them two or three times if they’re not regular patients. It’s not interesting to me just to see them for sore throats and colds. You don’t get to know them.”
Despite the number of patients and the location of his office in what is considered a poor area, Dickey does not run a Medicaid mill. “We don’t really have what you call a Medicaid practice, or a low-income practice. We had more of that the first two or three years but it’s tapered off so it’s about 25 percent welfare now.
“We have people who are making it now,” says Dickey, a native of a rural town in Minnesota who worked for the CIA for four years as a chemical engineer before entering medical school in the late 1960s.
With his practice now in its fourth year, “we have people with three or four children who are right above the Medicaid line,” Dickey says. “If you have three or four kids and are at that point, it’s tough.”
To make it easier, the physician charges his patients on a sliding scale, with those earning more than $22,000 a year paying $14 a visit - a low fee by city standards - and those making $10,000 paying $8. “It’s pretty evenly distributed over the scale,” he says.
Perhaps the most unusual feature of Dickey’s operation is that it is what is called a “joint practice,” with two nurse practitioners seeing patients along with the doctor.
There are no white uniforms in Dickey’s office, no white physicians’ coats. The doctor sees patients in an open-necked short sleeved shirt, slacks and hush puppies. Carol Grambo and Pat Tucker, the two nurse practitioners, are just as informally attired.
It’s hard to tell who’s the doctor without talking to patients and spending a good deal of time in the office. Dickey, Grambo and Tucker all do essentially the same thing - which means Dickey gives his own shots, draws blood and collects urine samples, this most physicians would leave to a nurse.
“Everyone does the same thing here,” he says. “I see kids in the hospital and acutely ill patients, but we share the load. If we have a lot of sick children, I’ll see them and they (the nurse practitioners) can spend more time with the well patients.”
Dickey says he and the nurse practitioners switch off, with the physician seeing the patient for one checkup, and one of the women seeing the patient the next visit.
In addition to providing the usual medical care and advice to his patients, Dickey also provides what nutritional and social counseling he can. When Denice Smith told the doctor that her 2-year-old son Jesse - who was in for a checkup - isn’t drinking much milk, he asked, “Does he like cheese? I’d encourage him to eat cheese. Do you buy the American squares? How many slices does he eat a day?”
“About one or two,” replied the mother.
“I’d encourage him to eat or three a day if he’s not getting enough milk. Do you eat yogurt?”
Smith shook her head no.
“You don’t like it or you’re not used to it?” He asked.
“I’m not used to it,” she said.
“Well, he might like it. If he gets half a carton of yogurt a day and then a couple slices of cheese, he’ll get all the calcium he needs.”
After examing Jesse, Dickey asked, “Is he at home with you now? Are you thinking of sending him to nursery school? Do you have any idea when?”
He listened carefully as Smith told him about a nursery school near her home, and then said, “I’m not too thrilled with nursery school, especially for a child this age. There’s always somebody bigger and rougher. He’s a nice, quiet boy.
“He’ll do just as well at home with you.” Dickey said. “Maybe some of your friends and relatives will tell you he’ll learn things. But if you sit and look at a book with him, he’ll learn as much in 10 minutes with you as he would all day in school. He doesn’t need to learn to fight. He’ll learn that later. He could use some extra love now.”
Later, he tells a visitor, “nursery schools are liked old people’s homes for children. If a child is neglected or abused, they can be a heaven but if the mother takes an interest. . .”
Most of the children “we see here, once we’ve seen them for a while, are basically health,” Dickey said. “We counsel the mothers, give the children vitamins, but the vast majority are healthy.
“But medical care doesn’t make much of an impact on health,” Dickey said. “The family makes an impact on health. The problems is that when they’re struggling to get by, health is low on the their list.”