Karen Sokol’s afternoon begins with a squirt of hand sanitizer from a bottle tucked in a pocket of her messenger bag. She rubs the solution thoroughly between her fingers and palms before sitting down to examine her first patient.
Charlotte MacNeill, a spry 92-year-old with bright, seawater-colored eyes, pulls over a chair — a handsome wingback that sits in the corner of her Converse Home apartment — and settles into it.
“How have you been doing?” Sokol asks, a laptop angled precariously on her thighs.
“Oh, pretty good,” MacNeill answers. “I’m basically a healthy person.”
Then MacNeill lets loose a torrent of coughs that sound like they hurt.
“How long have you had that cough?” Sokol asks.
MacNeill explains the cough has lingered for a few weeks. Maybe it’s allergies, she speculates. Whatever the cause, MacNeill thinks it’s on its way out.
Still, the hack appears to be causing her some discomfort. Cough syrup should do the trick, and a staff nurse measures out a dose and hands it to MacNeill, who tosses it back like a champ. MacNeill scrunches up her face as the medicine goes down. The examination proceeds.
Sokol asks after her patient’s appetite, sleep schedule and pain levels. Then she questions MacNeill about her weight.
“I think I’m 106, but that’s hard to believe,” MacNeill says, laughing. “Every woman would love to be 106.”
Sokol, 47, will repeat this exchange three more times this afternoon as she drives around Chittenden County visiting patients. A home visit like this one, where MacNeill’s examination took place in her sunny living room, isn’t a special service — it’s the only service Sokol provides.
Sokol, slim and energetic with shoulder-length chestnut-brown hair, says she’s the only family practice physician she knows in the region whose practice is based entirely on house calls. The Burlington-based doctor doesn’t have an office or a secretary or even a nurse to assist her. She’s a one-woman medical practice. It’s a model she says works better for her and her patients.
It’s hard to believe there are still physicians who prefer old-fashioned house calls, given that the current system of health care rewards them for fast treatment and high volume. But, says Sokol, the house call makes sense for her. It allows her to get to know her patients in a way she couldn’t in an office, as well as to set her own schedule to maximize time with her family. Plus, she reasons, her patients get a level of care that would be impossible in an office setting, where doctors are often pressured to get them in and out as quickly as possible.
Sokol came to medicine late in life, after a stint in the Peace Corps and an initial career in public health. She had always been interested in the profession — her father was a doctor — but was turned off by the seemingly endless hours.
But, in 1997, Sokol, then the mother of two young children, matriculated into the University of Vermont medical school on a part-time basis. She didn’t want to look back and regret a missed opportunity. In 2003, she became a board-certified physician and began working in family practice.
Though she had a brick-and-mortar office in Winooski, Sokol already harbored a desire to make house calls. She began by offering the service one day a week, primarily to her geriatric clients, for whom traveling to her office was difficult.
Quickly, Sokol was hooked. Interacting with patients in their own space brought a level of comfort and ease to the exam that she couldn’t achieve in an office setting, she says. Plus, she was becoming part of their lives and fostering more meaningful relationships.
“I always see my patients, in health and in sickness. I’m really getting to know them,” says Sokol, who sees her geriatric patients roughly once a month. “It’s a really unique way of practicing.”
Sokol’s house-call practice has its own set of challenges. While she has no overhead and sets her own schedule, it’s been a struggle to make the practice financially viable. She still has the same expenses as other physicians — liability insurance, electronic medical records software, academy membership, medical school loans — but she’s not able to see nearly as many patients. Depending on where her clients live, Sokol bikes or drives to the appointments, and that takes time.
In this day’s three-and-a-half-hour block, Sokol sees just four patients. A traditional practice would see at least double that. She could increase the volume, she says, but cramming her schedule would compromise the quality of the care patients receive.
Sokol acknowledges she didn’t get into medicine for the money, but she would like to contribute to her household finances. She laments that the current American health care system isn’t set up to pay for the personalized services and preventive care she provides: “You’re never reimbursed for quality care,” Sokol says. Some insurance companies won’t even cover home visits.
Sokol remains undeterred. She has no shortage of patients, most of whom are geriatric and have found her by word of mouth. She’s done no advertising and is booked solid through August.
The reason seems simple: She’s providing a rarely offered service that people still need. The Vermont Department of Health doesn’t track how many doctors make home visits, but it’s safe to say the practice’s heyday has long since passed.
At the Converse Home, Sokol peers into MacNeill’s ears and listens to her lungs before squatting on the ground to check the pulse in her right foot. She gingerly removes MacNeill’s brown loafers and examines the soles of her feet for sores.
Then Sokol asks MacNeill if there’s anything she wants to talk about. Again, MacNeill tells the doctor she’s always been pretty healthy and active. Then she begins to talk about her family. She was one of six children, and her father always made sure there was lots of milk to go around so the kids would grow up strong. Sokol sits on the floor and listens, a smile spreading across her face. At times, she plays this role of friend and confidant, especially to her older patients.
For MacNeill, the home visit is a treat. “I don’t have to get in a car and wait for a half an hour in the waiting room,” she says. “I feel spoiled.”
Sokol moves on to her remaining patients of the day, who are all in their eighties and nineties. She visits with Peg Whitson, an 86-year-old former sailor and artist, who lives at Cathedral Square. Whitson sits in a large, cushioned chair by an open window. A breeze blows the nautical-themed curtains. Sokol asks how Whitson’s been doing.
“Not very well,” Whitson replies. “I’m feeling weaker.”
Whitson is tired, and Sokol’s questions seem to exhaust her further. She tells the doctor that her ankles feel swollen and the shoulder exercises her physical therapist gave her hurt. Sokol listens intently, her face open and kind. She tells her patient she’ll see to getting her compression socks for the swelling, and she’ll check in with the physical therapist about the painful exercises.
After reminding Whitson of the safety hazards of a certain red step stool, and promising to talk to the Cathedral Square staff about adjusting the height of the apartment’s toilet seat, Sokol takes her leave. She has two more patients to see.
Sokol’s last visits of the day are shorter than the previous ones. These patients are nearing the end of their lives: One has heart and lung disease and takes morphine to help her breathe, and the other is in hospice care with heart failure at the Vermont Respite House in Williston.
Her last patient, a 96-year-old named Lee Gottlieb, nattily dressed in khaki trousers, a purple top and a matching vest, is napping when Sokol arrives, but springs to life when she sees the doctor.
“How have you been?” Sokol asks.
“As well as I can be,” Gottlieb says matter-of-factly.
Sokol asks about Gottlieb’s mood. It’s hard these days, Gottlieb says, because she misses her husband, who died a year ago.
“I miss a lot of the things I used to do. I guess I’m not all there,” Gottlieb says, her voice a squeaky whisper.
Sokol sits at the side of Gottlieb’s hospital bed, holding her hand, listening. Eventually, the conversation moves to death and dying.
Sokol reminds her patient that her heart is getting weaker. She explains that some people get sad and scared at the end of their lives.
“I am neither sad nor scared,” Gottlieb says, her tiny hand grasping Sokol’s. “These things happen. They do. And there’s nothing I can do about it.”
And neither can Sokol. She kisses Gottlieb on the cheek and says her goodbyes. She’ll be back in a few weeks, she promises.