He’s Rare: Doctor Who Makes House Calls

The early morning June haze had not quite lifted when Dr. Clarence H. Spence stepped out of his silver Honda sedan and hurried down the long row of mobile homes. At the other end waited a severely diabetic 54-year-old woman.

But before the doctor reached his destination, a cheerful woman emerged from between two homes and surprised him.

“Well, look who’s here! Am I glad to see you, Dr. Spence,” Olive Davis said as she reached to embrace him.

In her hand, Davis held a newspaper clipping. “Look, it says here that when we get really old, they’ll just kill us,” she told Spence. He smiled and assured her that he would never let that happen.

A former Navy doctor, Spence calls himself a point man of the medical community, meaning that he makes house calls. He visits more than a score of infirm patients weekly in Orange and Los Angeles counties.

For the last three years, the 55-year-old doctor has worked out of offices in Santa Ana and Hacienda Heights, slowly building his family practice. He also works a couple of nights a week in a hospital emergency room and treats prisoners twice a week at the Orange County Jail.

“I work day and night, sometimes seven days a week,” said Spence, a talkative man seemingly always in high gear.

In all, Spence drives about 3,000 miles a month between the two offices and on house calls to the elderly and the disabled. Geriatrics now constitutes about one-fourth of his practice.

“I just feel like they have earned their spurs. I want to help those people who are not sick enough to go the hospital but are bad enough that they can’t come to the office on their own,” he said.

Spence now visits about 25 patients at home and another 100 or so who live in convalescent homes or are mentally disabled youngsters.

“When you’re in family practice, you have to be a complete doctor. You are the quarterback,” Spence said. “Some of our patients can’t get here.”

A spokeswoman for the Orange County Medical Assn. said that although the county has 2,300 practicing physicians, “I am sure there are very few, if any at all,” who visit patients at home.

Dr. L. Rex Ehling, the director of the county’s Public Health Agency, said the agency has no information on doctors who make house calls because “that kind of service just isn’t provided.”

Spence, the father of six children, was born in Mississippi but grew up in Ohio. At age 17, he joined the Navy, retiring 31 years later. He was a flight surgeon in Vietnam for two years and later served as the air wing medical officer at the El Toro Marine Corps Air Station.

But his work as a civilian, he said, is much more grueling.

“In the Navy, I did not have to work. I had people work for me. Here I have to do it all myself,” Spence said. “Also, in the Navy, all you see is pilots and aviators. You don’t see sick people.”

After his military service, the doctor went to work with Dr. Clemencio Rodriguez, who has since died. Rodriguez, a native of Argentina who practiced in Whittier, got Spence interested in geriatrics and became his mentor.

“Nobody wanted to take care of old folks, so he did it. I learned a lot from him,” Spence said.

His Demeanor Helps

Some of his patients say that Spence’s concern and gentle demeanor help as much as his medical care.

“He’s just great. Everybody loves him. He loves his patients,” said Davis, 74, who has been Spence’s patient for three years. “He really cares about all of us and it shows. Everyone is the same with him.”

On the morning that Spence encountered Davis in the driveway of the Santa Ana mobile home park where she has lived for two decades, Jessie Ruth Raia waited in the cramped mobile home she shares with two friends. Raia has lost both legs to diabetes and now gets around on artificial limbs.

Her blood sugar must be checked periodically. She is driven to Spence’s office in a special van operated by the Orange County Transit District.

‘That’s Important’

“She’s better off with me coming here. The bus might take a long time to get here. This way, she doesn’t have to miss a meal and that’s important with her diabetic condition,” Spence said.

After leaving Raia, Spence drove to a quiet neighborhood in northwest Santa Ana to visit Josephine Dalone, 80, who has a heart condition.

Dalone, a thin, tiny woman wearing a new pink gown, greeted Spence in her sunny bedroom. He hugged her before checking her condition. Dalone’s daughter, Beverly J. Patton, with whom she lives, looked on.

Patton, a nursing supervisor at Western Medical Center in Santa Ana, said that her mother has been hospitalized three times in the last year and that her illness has become progressively worse.

‘This Is Much Better’

“But I feel very confident with Dr. Spence. There’s no way I could take her to the hospital,” Patton said. “This is much better than a convalescent home. I tell you, we really appreciate our country doctor in the city.”

Although Spence is gradually taking on more home patients, he charges only what Medicare or Medi-Cal provides, about $35 a home visit.

“You don’t get rich with this kind of practice, but I wouldn’t think of charging them money out of their pocket. They are already on fixed incomes,” he said.

Spence also predicts that doctors who make house calls will become “prevalent again in five or six years. We have to lean closer to this large patient population.”

Income a Problem

But Ehling, the county’s public health director, said there might not be enough financial incentive to entice more doctors to visit patients at home.

“There is no doubt that home health care is preferable, and it would appear that kind of care would be less costly,” Ehling said. “But it has to depend on whether there would be (enough) reimbursement. You would need strict management controls, and it is hard for an insurance company or for the government to build that in.”

Regardless, Spence said he will continue driving his Honda toward the homes of his patients.

“This is a very enjoyable practice, but it is very challenging as well,” he said.