ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, December 29, 1996 TAG: 9612300101
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
DATELINE: BIG ISLAND
SOURCE: RICHARD FOSTER STAFF WRITER
A few years back, after a long hike through the snowy mountains, Dr. George Wortley and one of his interns reached the log cabin of one of Wortley's oldest patients. No smoke was coming from Elmer Bryan's chimney.
``I thought, `Uh-oh. This is bad,''' Wortley recalled. ``We found him in bed. It was 25 degrees outside and 25 degrees inside his house. The place was stone cold and he was shivering in bed under every blanket he had.''
The patient, past 90, hadn't been taking his medicine and was too weak to bring in wood for a fire. "We split some wood for him, loaded it up in his fireplace, and started him back on his medication," Wortley said.
When he got back to his office, the doctor got in touch with Bryan's friends and neighbors. "That's the great part of a rural practice. You can call up the neighbors and church groups and get them to come by and load up his fireplace until he gets past the couple of days when he can't do it for himself."
To say Wortley believes in making house calls is an understatement.
This summer, he canoed to a remote area on the nearby James River to treat a teen-age hiker who had fallen and hit her head on a rock. During last winter's blizzard, when even the National Guard's armored four-wheel-drives couldn't negotiate the snow-covered mountain roads, the 44-year-old doctor skied three miles across hilly terrain to treat a woman having a severe allergic reaction.
"I don't make house calls on young, healthy people who have a sore throat, obviously," Wortley said, but "house calls are a tradition in rural areas. If you don't go out and see them, there's no other way to see them."
He usually makes at least one house visit a week, most often to invalids or elderly patients who have trouble with transportation.
Wortley is fond of saying "disease does not exist in a vacuum"; his visits to patients' homes don't focus only on their present ailments. He tries to learn what else could be done to improve their health.
"Is the house heated? Is there food in the refrigerator? Do they have help at home? Does the roof leak? There's just so much you can tell about about a homebound person at home," he said.
On a recent December day, Wortley packed a blood pressure cuff, stethoscope and blood vials and drove out a winding dirt road through cow pastures to check on Jack Tomlinson, a 75-year-old cattle farmer recovering from a stroke.
Tomlinson's feet had been swollen and he had trouble walking or even getting up. Wortley examined Tomlinson in his recliner, checked his walker and made sure he could use it, and offered suggestions on ways to reduce his discomfort. As Wortley listened to the man's heart, they commiserated over low cattle prices and talked about Tomlinson's son, who is minding the farm.
After leaving, Wortley said, "When you consider he was born on this farm and he stayed here all his life, it's important to keep him here. To put him in a nursing home would be the end of him. This is the land he's connected to, and to take that away from someone in his latter years, I think that would be a real shame."
`A role model'
Wortley also uses his house calls to teach the medical students and interns who study under him at the Big Island Family Medicine Center. It is an arm of the Lynchburg Family Residency Program, a cooperative venture between Centra Health and the University of Virginia.
Wortley, considered a clinical assistant professor of family medicine for UVa, instructs third-year medical students and residents from across the country in the art of rural medicine.
UVa can place students with more than 300 doctors in Virginia, but very few are in rural areas. There's a nationwide shortage of rural doctors, and those who do have rural practices usually can't take time out to instruct a student because they're too busy trying to keep up with their own patients, said Dr. Mike Morse, a UVa professor of family medicine.
About 20 UVa medical students study for two weeks in Big Island with Wortley every year, and 12 residents from the Lynchburg program each spend a month there. As a medical adviser and volunteer for the Big Island Life Saving Crew, Wortley also sends his students on calls, or brings them with him on emergencies.
Wortley, the son of a former four-term Republican congressman from New York, lives on a 37-acre farm in Big Island and has practiced in the northern Bedford County paper-mill town since 1989. Before that, he practiced in Bedford, and a college town in New York.
Wortley has been married 22 years. His wife, Susan, is a teacher at Lynchburg General School of Nursing. They have three children, ages 16, 18 and 20.
He spends two days a week in the Big Island office and the other three at the family residency program in Lynchburg. On Wednesday, however, he will stop seeing patients in Lynchburg and will devote four days a week to his practice and teaching in Big Island.
"I'm primarily a role model, trying to get these young doctors in residency to go into rural practices," Wortley said. "Me, as one rural doctor, can only see so many patients, but if over the course of my career I can inspire 20 people to do what I'm doing, I think it would have a much bigger impact on rural health."
Rural people aren't the only ones whose health care Wortley worries about. One of his main interests these days is the Free Clinic of Central Virginia in Lynchburg, where he volunteers several days a month as medical director and physician. He speaks passionately about its working-poor clients:
"People working minimum-wage jobs without health insurance or benefits, they can't afford to be sick, and where do they go when they get sick?"
Rebecca Noftsinger, executive director of the Free Clinic, said, "I don't know anybody that does as much and as many different things as he does, and one of the things I appreciate so much about him is if that night comes along that we're in a real jam for a volunteer, and we let George know, he will come. If George is in town, he will get here. He just has an incredible commitment to the Free Clinic and our patients."
`Made it fun'
Dr. Richard Elsea, who practices in Churchville near Staunton, studied under Wortley as an intern from 1991 to 1994, pulling several rotations treating patients in Big Island. He said he always wanted to be a rural doctor, but probably wouldn't be as good at it without Wortley.
"George does a lot of hands-on treatment, things the other doctors wouldn't do, and he takes a lot of time with people that other doctors don't do," Elsea said. "A lot of other people would consider [house calls] a chore, but he made it fun, and there's a lot you get in return for that."
Elsea was the intern who split wood with Wortley. He also recalled another visit with Bryan, who has since died.
The elderly patient was a bluegrass enthusiast and musician, but couldn't play anymore because of the sore joints in his fingers, so he asked Elsea to play a couple songs on his guitar.
"I played a few bluegrass songs I knew. It was a cold, snowy day, and here's Elmer in his 90s, flat-footing it while I was playing, and George was clapping his hands," Elsea said. "It was definitely not your standard doctor-patient interaction."
That's what Wortley said he finds so rewarding about his practice in Big Island. "I always thought practicing in a place like this that you'd have a front-row seat in the theater of life," he said. "I'm just attracted to a small community because I like the connections between people. I have some five-generation families in this practice, where I see everyone from 5-year-olds to 90-year-olds in the same family."
Dr. Monique Gibson, a resident at the Lynchburg Family Residency Program who has studied under Wortley and treated patients in Big Island for the past month, said Wortley pays attention to more than just a patient's medical history. "He knows the patients, he knows their families, he knows their life stories. He's what a doctor should be."
Closeness with patients is just one of the perks of a rural practice, the way Wortley figures it. Another is the mountain setting. An accomplished outdoorsman, Wortley's hobbies include hiking, canoeing and rock climbing, and he likes to take his students and residents on backpacking and camping trips.
He said residents are "kind of afraid to go out with me" because his hiking trips "usually turn out to be twice as far and twice as hard as anybody planned."
His athletic interests prompted him to become board-certified in sports medicine. This season is his 10th as team doctor for Roanoke's professional hockey team, now called the Express. He also serves as medical director for runs in Lynchburg and on the Appalachian Trail. This past summer, he volunteered for two weeks as a physician for the U.S. Olympic Training Committee in Colorado.
Wortley treated William Putney, father of Del. Lacey Putney, I-Bedford, before the man died this year. Putney said he isn't sure how long Wortley cared for his father, but "I tell you, it doesn't take long for you to be a patient of Dr. Wortley's and feel he's been your doctor for ages. Every patient is special to Dr. Wortley. My dad didn't want anybody to come near him except Dr. Wortley" or his residents.
Putney said, "In this high-tech, fast-rush, computerized society, it is surprisingly reassuring to see members of the medical profession who genuinely care about people."
LENGTH: Long : 176 lines ILLUSTRATION: PHOTO: NHAT MEYER Staff. 1. Dr. George Wortley talks in hisby CNBoffice with longtime patient Laura Martin of Bedford about her
prescriptions. 2. For house calls in his wide-ranging country
practice, Wortley finds his four-wheel-drive vehicle indispensable.
3. Dr. George Wortley listens to Jack Tomlinson (above) describe the
problems he's been having since his stroke a year ago as Tomlinson's
wife, Rena, listens. 4. At left, he checks Tomlinson's breathing and
afterward (below) answers Rena Tomlinson's questions on the walk
back to his car. 5. Wortley makes house calls most often to invalids
or elderly patients who have trouble finding transportation. He
doesn't, he said, do it for ``young, healthy people who have a sore
throat, obviously.'' 6. (headshot) Wortley. color. Graphic: Map by
staff. color. KEYWORDS: PROFILE