The Washington Post

Rare D.C. house-call doctor straddles two Washingtons

Isak Mauritzon, 11, and his family, visiting the District from Sweden, were set to visit museums in the city last Wednesday when Isak complained that his ear hurt. His parents, looking for a doctor, called the hotel receptionist, who gave them Ernest Brown’s number.

Less than an hour later, Brown, 46, walked into the Mauritzons’ hotel room carrying a black satchel and blue duffle bag full of medical equipment. He wore his signature blue scrubs with the words “House Call Doctor” stitched in red on the back.

Brown is a rarity: a family medicine doctor who performs house calls. Working mostly in the District, he’s fully independent and unaffiliated with insurance programs.

His work straddles two Washingtons. His paying patients are foreign and domestic travelers, including foreign dignitaries, staying at the city’s hotels. Treating those clients allows him to serve as the primary care doctor — pro bono — for more than a dozen elderly homebound residents in poorer neighborhoods.

Brown’s form of practice is “still fairly uncommon,” said Tom Blue, chief strategy officer of the American Academy of Private Physicians. In a 2013 survey by the American Academy of Family Physicians, just 3 percent reported making house calls more than two times a week.

Dr. Ernest Brown, 46, an independent family physician, examines Isak Mauritzon, 11, of Sweden inside a hotel room in Northwest Washington on Aug. 13 as Isak's mother, Sofie Mauritzon, watches. (Astrid Riecken/For The Washington Post)

Brown had planned to go into emergency medicine, but in 2001, he changed course.

As a third-year medical student at Howard University, he was in a rotation with an older doctor one day when he observed the physician reach out and hold an elderly patient’s hand. “Mary, I think you’re doing great,” Brown recalls the doctor saying. “See you at home in a week.”

At first, Brown didn’t understand why the physician would go see the patient at her home. He then learned that the physician’s primary practice was in house calls. Months later, with that memory still with him, Brown visited Cuba as part of an exchange program with Howard’s medical school. At a cultural festival held in honor of the program, he recalled seeing people cheering for an elderly man who was dancing. It was the local doctor.

The two experiences made Brown realize how much he valued community in his medical career.

After completing his residency in 2008, he started working through a nonprofit house-call program, but it ran out of funding. He then focused on developmental disabilities and then shifted back into a house-call program.

“I can do more in a house call in one visit than I can do in years with a patient in a clinic,” Brown said.

A person’s environment can help determine his or her health, he said. For instance, he can request permission to check a diabetic patient’s refrigerator. If he finds tubs of ice cream in the freezer, he gets a better sense of the person’s lifestyle than he’s likely to have from one conversation during a hospital visit, he said.

Dr. Ernest Brown, 46, an independent family physician, fills out a new house call request inside his car, which basically serves as his office, on his way to a patient in Washington on Aug. 12. (Astrid Riecken/For The Washington Post)

But by 2011, he was tired of working for other people and dealing with insurance paperwork and delays, so he decided to go independent.

“I like to have the freedom to practice medicine. Period,” said Brown, a divorced father who also appreciates the flexibility his practice affords for spending time with his 11-year-old son.

By the time he went into business for himself, Brown already had friends in the hotel concierge business, who circulated his name and number whenever an illness came up that threatened a vacation or business trip.

Such was the case with Isak Mauritzon. When Brown arrived at his hotel room, a barefoot Isak was sprawled out on one of the queen-size beds.

His mother, Sofie, and sister, Asta, sat on the other bed while his father, Hikan, greeted Brown and answered the doctor’s questions, with Sofie interjecting on occasion.

The boy sat up so Brown could examine him. Brown determined that the boy had an outer ear infection — along with a possible inner ear infection — and pulled antibiotics from his duffle bag.

Hikan furiously jotted down Brown’s dosage instructions on a notepad. The doctor left amid a flurry of thank-yous from the boy’s parents.

Brown makes his living from such work, with house-call visits to hotels, private residences and embassies numbering 10 to 15 a week. His charge starts at between $300 and $400, which covers the visit and any follow-up visits. The fee rises with other factors, including whether additional supplies are needed, the amount of travel involved and after-hours work.

He asks patients to follow up with him in a phone call. And he doesn’t charge his hotel clients until they’ve improved, staying in touch by e-mail.

He doesn’t really worry that they’ll skip out on paying. “It’s all about good faith,” Brown said.

Payments from those visits allow Brown to perform charity work for homebound patients in Northeast, Northwest and Southeast Washington.

Starting in 2011, Brown took on more than a dozen primary-care cases — patients he met back when he worked with nonprofit house-call programs. For these aging patients, largely on Medicaid or Medicare or both, Brown does not charge for being their primary care doctor.

“Ernest Brown is a family physician, an altruistic family physician,” said Robert Wergin, who is president-elect of the American Academy of Family Physicians. Wergin was treated by Brown once on a visit to the city.

“The business part of it comes secondarily to him,” he said.

Dolores Cook, who was a patient of Brown’s when he contracted with a house-call service, is now in a hospital house-call program. But Brown still pays the 81-year-old Cook, who had a stroke, a visit every couple of months at her home in Northeast to ensure that she is properly cared for. If Brown has any concerns, he advocates for her with the hospital program.

When he visited Cook on Wednesday, after her recent discharge from the hospital, he was greeted with several tight hugs from Cook’s daughter, Jacqueline Frye, 65, who lives with her mother and helps take care of her.

Cook napped on a hospital bed in a very warm bedroom. A small AC unit blasted out small bursts of cold air, and a “Happy Mother’s Day” balloon was still floating in a corner.

After talking a bit with Frye about her mother’s condition, Brown walked over to his patient.

“Hello, Dolores,” Brown said as the woman’s eyes flickered open and lit up. Cook smiled at the familiar face.

Brown proceeded to ask Frye about her own health. He was aware that her older sister, Brenda, died last year of a heart attack. She was Cook’s previous caregiver, and Brown attributes her death partly to caregiver burnout.

Frye explained how she was recently diagnosed with diabetes. Brown asked her how she was keeping up with medication and other treatment.

“It’s just pricking that finger,” Frye said with a shudder.

She laughed when Brown gave her a knowing look and asked if she was actually going through with testing her blood.

Before leaving, Brown left Frye instructions for caring for Cook and reminded her that she needed to care for herself, too. Frye thanked him and reminded him that he needed to come over for dinner soon.

In the future, Brown hopes to hire other doctors to handle the paid house calls so he can devote himself to charity work, especially in Southeast, where he’d like to see more patients.

He acknowledges that not everyone wants to have an on-call, 24/7 kind of practice. His colleagues who work in hospitals are paid at least twice as much as he is, he said.

Yet even with having student loan debt, Brown can’t envision himself doing anything else.

“For me, right here, right now, this makes sense,” Brown said.


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