It’s a comfort to know that before Dr. Tom Nicholas and Dr. Dan Dwyer shutter their family practice in Rockville later this month, they’ve seen to it that another physician will be taking their place.
Typically, as they have proven so many times over the past 45 years, the two long-time friends and partners look after their patients first.
Rural and small town doctors are an increasingly rare breed in this country; according to a Washington Post article last year, the federal government now considers 80 percent of rural America as being “underserved,” and more than a quarter of those practicing medicine are over 60 years of age.
Nicholas and Dwyer, both now past 70, feel the time is right to start the rest of their lives away from the office — originally a turn-of-the-century auto garage on High Street — that they’ve spent countless hours in since the summer of 1975.
Nicholas recalls that it was 1968 when the two men — he, born in Denver and raised in Indianapolis, and Dwyer, a Terre Haute native — first considered practicing medicine together; it was pretty bold talk for two sophomore life sciences majors at Indiana State University.
“We were sitting in my 1952 Chevy, parked behind the Life Sciences building, and we had no direction, and we had been rivals turned friends, pushing each other to be in the top of every class we took,” Nicholas says. “I mentioned that my family had doctors in it, but I was thinking that it took such a long time [to become a physician]. We chatted about it for a few weeks,” Nicholas adds, “then made the decision to go for it. We knew it would be a struggle, and did we ever push each other, like Mantle and Maris.”
The pair spent time after classes studying together, then studying alone at night. “Then it came time for the MEDCAT test and interviews,” Nicholas says. “We were separate, but knew inside what the other knew on the test and would say in the interview. We were in the first mailing to get the acceptance letters [to Indiana University’s School of Medicine].”
Although Nicholas has been my family’s doctor for over 40 of the years he’s been in Rockville, we’ve also been well-served by Dwyer. One or the other has always been available on weekends when the inevitable call had to be made: a gash that needed closed; a fever that wouldn’t abate; hornet stings that needed attention. And, over that time, both have become “jacks-of-all-trades” that have become increasingly rare in medicine over the past few decades; lab work, x-rays, minor surgical procedures included.
“The main reasons we did so many things in the office,” Nicholas says, “is we wanted to offer a wide range of medical care, not just the quick and easy and then refer the more difficult and time-consuming cases to a specialist. We went out of our way to be proficient at skills in our training, realizing that we were moving to an area that did not have, especially when we first started, the luxury and security of having a lot of specialists. Our patients loved it.”
I have often kidded with Nicholas that we’ve had the perfect doctor-patient relationship: I’m a bit clumsy and he enjoys practicing his surgical skills. In one particular incident — or should I say, accident — it was Nicholas who sutured a deep cut on my knee, and Dwyer who removed the stitches a few days later.
“For the past 45 years I have been ‘watching over’ my patients. It’s time to pass the torch, but I fear the health care providers may not ‘watch over’ my patients as well as they should,” Dwyer says. “This perception comes from my patients’ observations. Students and doctors need to be made aware that being a good physician is more than a 9-to-5 job.”
Nicholas says that he and Dwyer agree that their patients should get three things when they encounter a health care professional. “First, what is our diagnosis, or our working or differential diagnosis? Second, what are our options for treatment and which do we recommend? And third, what, if anything, can we do as part of our health care team to avoid a return of the condition that led the patient to this visit? With these three simple things, I think our patients have a meaningful experience.”
It has become apparent that the kind of doctoring Nicholas and Dwyer offer is disappearing, despite a desperate need for it. My wife and I grew up seeing a small town general practitioner, and we knew that was what we wanted for our family; we still do. But according to a piece on NPR’s “All Things Considered” last year, practices like those of our two friends are going away forever.
“Only one percent of doctors in their final year of medical school say they want to live in communities under 10,000 [people]; only two percent wanted to live in towns of 25,000 or fewer,” the program reports. “Taking over a small-town practice is too expensive, or in some cases, too time-consuming for younger, millennial physicians. And a lot of the newly minted doctors out of medical training are opting to work at hospitals, rather than opening their own practices.”
One of the things I have always enjoyed — if I can use that term in reference to a doctor’s visit — is the distinct harmony the two men have, despite being considerably different individuals. Dwyer, sometimes in hiking boots and blue jeans, is always quick with a joke and once related a story to me about an outdoor privy he was building; Nicholas prides himself in sketching anatomical explanations on the back of prescription pads and makes his visits conversational events. Patients might spend a good while waiting for him to walk through the exam room door, but know he is going to spend just as much time with them as he had with a previous patient.
“I truly believe God has blessed our profession, but I also believe we professionals need to practice as if God is watching over us,” Dwyer says. “I am anticipating a return to manual labor and taking college courses in geology, astronomy, and anthropology,” he added.
“I think what is truly remarkable,” Nicholas says, “is we walked in together as best friends, and we’ll walk out 45 years later as best friends. Dan and I have always known we’ve had each other as back up, and at this time, as we approach almost a hundred years of experience together, we still ask the other to step across the hall and ‘have a look at this.’ We’ve trusted each other,” he added.
We’ve trusted them, too.