MEMORIES OF FAMILY GP FADE IN ETHER TODAY'S HEALTH CARE GETS NEW PROGNOSIS -- FOR BETTER OR WORSE.

Byline: SUSAN ABRAM

Staff Writer

BURBANK -- Dr. Herbert Rubin calls helping people his religion.

After more than 50 years, he's still devoted to his profession. He believes a patient is a human being who matters. And he puts his beliefs into practice, charging $40 for a routine visit to his modest Burbank office, making house calls to those who can't come to him.

His humble practice harkens back to a time not all that long ago when family practitioners charged $2 for an office visit and $5 for a house call.

And it's a far cry from utilitarian urgent-care clinics and the crowded emergency rooms where many of today's patients seek treatment.

"When I first started working for Dr. Rubin, we did everything in this office -- sutures, casts, biopsies. But then the HMOs came along and said we couldn't do it," said Stella Rodriguez, who has been Rubin's office manager for 25 years.

"Our patients get upset when we have to refer them, and they can't see a specialist for weeks. They end up going to the emergency rooms just to see a doctor. It's very sad, especially for the seniors."

Rubin concedes that technology has vastly improved medical care, but notes that patients still long for a touch of bedside manner. He feels as though complicated health plans and high insurance costs have wedged themselves between his patients and the care he wants to provide.

"We have no control anymore," said Rubin, a World War II veteran who went to medical school on the GI Bill. "I used to be in control. They came to me and I would take care of it all. Now, I'm what they call a gatekeeper."

The way it was

Don Whittemore can well remember the special attention he got when he was 11 and developed the symptoms of polio, a contagious disease that left tens of thousands of people paralyzed before a vaccine was discovered in 1955.

"I was real stiff, and my mother wanted me to go to the doctor but I didn't feel good enough to go to the doctor," said Whittemore, 68, who runs Dandy Don's Homemade Ice Cream in Van Nuys.

So the doctor went to the family's San Francisco area home, where he diagnosed the youngster with the frightening condition. The doctor called an ambulance, and Whittemore found himself quarantined in the hospital.

For the next month, a nun draped wet steaming towels over his legs to revive his atrophying muscles. He had physical-therapy sessions in a warm pool. Unlike one of his four roommates, he was spared the iron lung, a hulking contraption that helped the most critically ill breathe.

Among Whittemore's most vivid memories are the times the family doctor came to see him in the hospital -- not simply to treat him but to help pass the time.

"Not the kind of run in, run out and make a lot of money -- now it's just kind of highway robbery," he said. "It's all a system."

The way it is

The Emergency Department at Northridge Hospital Medical Center has locks on the doors between the waiting and examination rooms and bulletproof glass in the service window between nurse and patient, just in case anyone gets out of hand.

A gunshot or stab wound or severe trauma from a traffic crash will get a patient treated by a staff physician in one of the examining areas.

Less severe problems -- a broken wrist, a twisted ankle, a dislocated shoulder -- get a patient referred to see a doctor in a day or two.

"We used to have private rooms for patients in 1978. In 2006, we have hallway beds," said Dr. Stephen Jones, the Emergency Department director. "The reality is when it's getting crazy, a gurney in the hallway is the only place we can put them."

Jones can recall just 20 years ago being able to catch a catnap during long, late-night shifts. That was when the ER at the Northridge trauma-care center treated 30,000 patients a year, tops.

Now it sees up to 50,000 people, many of them uninsured residents who use the ER as a clinic -- a practice that puts a critical drain on hospital resources.

"The difference in the emergency room has to do with the changes in primary-care medicine," Jones said. "What happens now is more often people are unable to get in and see their doctor. They feel they can't wait, so they go to the emergency room. We are seeing conditions that could have been treated at a doctor's office.

"People feel they don't have that connection to their doctor as they used to," Jones said. "People are feeling like they aren't getting their needs meet, so they come to the Emergency Department."

Some change is better

But not everything about the good ol' days was actually good, doctors, nurses and volunteers say.

They can remember when an ambulance doubled as a hearse. When heart attacks were treated with 10 days of bed rest. When anesthesia meant pungent ether poured onto a gauze mask.

"Part of the reason doctors made house calls was that patients were too sick to be transported in a truck that had no heating, no air conditioning," said Dr. Robert Marsh, a retired surgeon from Glendale Adventist Hospital. "When you did go to a house call with a little bag, you were not well-equipped."

Ruby Haynal became a nurse in the 1970s because of the positive experience she had with those who treated her when she contracted scarlet fever as a girl.

"I think it was my own illness that encouraged me to become a nurse, because I liked the nurses," said Haynal, now 78 and retired. "For the better part of the year, I got acquainted with them. These people were taking care of you and knew what to do."

During the height of her career, Haynal said, nurses spent more time with a patient than they do today, but really knew very little about them.

"There was no emphasis in nurse and patient education as there is now," she said. "I don't remember much emphasis on that when I was young.

"You told a patient your name, what you were going to do, but you didn't put forth the effort or feel the need for patient education.

"A nurse was assigned to give all the meds. Another did all the baths. There was a task assigned for each so that you didn't know the whole picture of a patient. I think that has improved."

Moving forward

A doctor for about 20 years, Jones has been able to track the medical and technological advancements, such as Northridge's specialized cardiac unit and on-call cardiologist, who are specially trained to resuscitate patients suffering heart attacks.

"Paramedics will bypass the hospitals that don't have this unit and come to us," he said. "We are doing procedures in rapid time, sometimes 90 minutes, sometimes even in 60 minutes. The mortality rate was close to 25 percent and now it's 6 percent."

And with the advent of nuclear medicine, the guesswork involved in making diagnoses has been eliminated, Jones said.

He also said more hospitals are moving toward paperless patient files. Computers are being installed by each bedside so a physician can glance at the files with a patient, encouraging more dialogue.

"I can't spend as much time as I could speaking with each patient as I did 10 or 15 years ago," Jones said. "But all in all, I'm happy with what we're doing for people today."

Staff Writer Julia M. Scott contributed to this report.

susan.abram(at)dailynews.com

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CAPTION(S):

7 photos, box

Photo:

(1 -- color) Dr. Herbert Rubin discusses a patient's chart with medical assistant Cynthia Persky at his Burbank office. In an era of urgent-care clinics and problematic health plans, Rubin charges only $40 for a routine visit and makes house calls.

Tom Mendoza/Staff Photographer

(2 -- color) Pre-1900

(3 -- color) Discovery of antibiotics

(4 -- color) no caption (no smoking sign)

(5 -- color) Birth of modern medicine

(6 -- color) Expansion of care

(7 -- color) no caption (food)

Box:

Evolution of a doctor's visit and the discoveries that changed care

Sources: Patrick Dowling, MD, MPH, chairman of UCLA Department of Family Medicine; Dora Weiner, professor of medical humanities at UCLA; Kaiser Family Foundation; National Cancer Institute

Warren Huskey/Staff Artist