One recent Tuesday, a physician named K. Allen Greiner paid a house call. Greiner has known the patient for eight or 10 years, but the home visit was a first.
The two had met at a clinic in Kansas City, Kansas, where Greiner was working as a volunteer. The patient came in with an infection. He had recently been released from a state prison.
Greiner continues to see the patient at a clinic at the University of Kansas Medical Center. The patient has emphysema, and his health has declined to the point that he requires in-home nursing care. "He's really smoked himself to death," Greiner says.
His lungs shot, the patient likes to pretend that Greiner's lack of expertise is what's keeping him from getting well. It's an absurd premise. Greiner is a professor and the associate chair for research in KU Med's Department of Family Medicine. He is a principal investigator on two projects that have received nearly $12 million in grants from the National Institutes of Health.
The titles and grants don't mean anything to Greiner's patient, who some days lets his physician have it for 15 minutes. The patient tells good stories — about the military, about prison, about urban life in KCK — which helps Greiner put up with the abuse.
"Sometimes I just like talking to him," Greiner says, "even though he's just yelling and screaming and complaining."
The home visit lasted 30 or 40 minutes. Before he left, Greiner sprayed for roaches.
House calls are an infrequent but important part of Greiner's work. Seeing the way his patients live, he says, helps him become a better caregiver and researcher.
Also, his patients seem to like it. "People appreciate that stuff, and doing it once doesn't kill you," Greiner says.
From the time he was a medical student, Greiner has been thinking about how to improve his profession. There's room for it, to be sure. Health care accounts for about 18 percent of the U.S. economy. But the resources, vast as they are, deliver only mediocre results. Babies born in the Czech Republic and New Zealand, for instance, are more likely to reach their first birthdays than their American counterparts.
Greiner says it's outrageous that U.S. health care consumes so much wealth when millions of people lack insurance.
"We're wasting insane amounts of money on medicine and health care now, and we're not providing anything to large chunks of our population," he says. "And we've just chosen to do that."
Greiner's ideas for repairing the system make some of his colleagues gasp. Doctors, he says, make too much money. He would also like to change the way physicians interact with their patients. Is it unreasonable to ask family doctors to give out their e-mail addresses? Greiner doesn't think so. "I've been doing it for years," he says.
Greiner's admirers include Dr. Sharon Lee, the executive director of Southwest Boulevard Family Care. Greiner volunteered at the safety-net clinic when he was a medical student. His intelligence and compassion stood out even then, Lee says.
"He became the student that we sort of judged everybody else on," she says. "He became the gold standard. It made it hard for others to compete."
Greiner's work has also caught the attention of business executives. Emil Peters, a senior director at the Cerner Corporation, a health-care information technology company, met Greiner through a mutual friend. They talked at lunch about ways to improve the health of underserved populations.
"If medicine and health care could be administered by guys like Allen Greiner," Peters says, "we'd have no problems."
Greiner hated medical school. "I was totally miserable," he says. "I couldn't stand it here."