NEW LONDON, N.H. — The voice sounded like a child crying. It seemed to follow Dr. Anna Konopka around, echoing through the rooms of her house. She thought it might be coming from the neighbors — but no, it was inside her own walls. “Mrs. Ghost,” she called it.
She didn’t tell anyone. They would think she was unstable. She was a primary care doctor, treating both children and adults. It wouldn’t do for people to hear she had ghost trouble. Finally, one night around midnight, as she was getting ready for bed — there it was, in her room, sobbing. “I said, ‘All right, what do you want from me? I will . . . pray for you for three days. Let me know if it is enough,’ ” Konopka recalled. “And she stopped crying. She never followed me again.”
Konopka takes that same in-your-face approach to everything. As a high schooler in 1940s Poland, when all her classmates dug out their rattiest, most proletarian clothes for the Communist Party meeting, she wore her fur coat. More recently, when she heard that doctors at the local hospital had lodged complaints about her, she drove over to uncover their motives herself. And in early November, after she gave up her license so that the New Hampshire Board of Medicine wouldn’t suspend it, she went to court so she could get it back.
She is 84, and has become a symbol — if an eccentric one — for a kind of physician autonomy that is almost extinct in our era of highly regulated medical care. She works alone in a cottage beside her house, with no receptionist, no administrators, no nurses, no hospital affiliations. She has a computer, but she doesn’t use it much. She keeps her files in a cabinet in her office, page upon handwritten page of careful, old-world lettering. She does not take insurance, instead charging patients $50 cash for each visit.
But her case also brings up the debate over how best to ensure that older doctors are providing up-to-date care.
“This is one of the big questions in the field of medical education: What should we be requiring of older doctors in terms of demonstrating the maintenance of the skill required to practice medicine?” said Dr. Anupam Jena, a health economist at Harvard and a physician at Massachusetts General Hospital.
Research by Jena’s team found that older hospital-based internists tend to have higher mortality among their inpatients. That correlation can’t tell you anything about a single person’s abilities, though. Like drivers, doctors can be a menace at any age. Some might be the best practitioners around at 75, while others might be malpractice magnets before age 40.
Yet many doctors bristle at any talk of increased oversight — and Konopka is even more defiant than most.
“You are with the system, or you are out of the system,” she said. “It’s like communism: If you are out of the system you are treated as an enemy. . . . I am practicing traditional medical arts. They manage the patient and I treat the patient. I’m not going to compromise.”
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To see Konopka, you drive past a trout-filled lake, along a country road, until you see a mailbox sign that reads “A. M. Konopka, M.D.” Her black labradoodle greets you with growls, then nuzzles you with his head.
Inside, the place feels at once quaint and cosmopolitan, like a professor’s mountain retreat. When she reaches for the otoscope or stethoscope, Konopka looks out at raspberry canes and black currant branches giving way to forest. The air smells distinctly of tongue depressors. In her consultation room, your eye is drawn to a book called “Urine Under the Microscope” and to a toy piano resting on the “Physicians’ Desk Reference.” The walls are filled with Polish paraphernalia, Catholic imagery, and, most prominently, medical degrees and certificates in frames.
Those documents of competency weren’t easy for Konopka to get. When she was born, in 1933, her father was a judge in Rzeszow, about 60 miles from Ukraine in one direction and Slovakia in the other. But by the time she was graduating from high school, the country was aligned with the Soviet Union, and her family had lost almost everything except their reputation as members of the gentry.
“They wanted to recruit me for the Communist Party. I told them that I am not interested because my moral standards and their moral standards — they are two different standards,” she said. “Therefore they put me on the blacklist.”
No Polish medical school would accept her. She waited three years, cleaning laboratories. Then, after Joseph Stalin died in 1953, the Polish government became a little more forgiving and Konopka started medical school.
When she came to the United States in 1961, she had to prove her competency again, taking exams, doing residencies and internships, getting licensed in two different states. She worked in hospitals in New York and New Jersey, eventually moving to New Hampshire, where the climate reminded her of home. She worked part time for the Department of Corrections, and examined families in the green-shuttered office next to her house.
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The complaints from other local providers began three years ago, she said.
The one case that has been made public came to a head in September 2014. A 7-year-old patient Konopka had been treating for years allegedly came into her office with a heartbeat that was too fast and strangely patterned. According to documents from the state medical board, the doctor suspected this was a side effect of an asthma medication she’d prescribed, so she changed the prescription. But the board claims that she failed to do certain follow-up tests or refer the child to a cardiologist — and that she had not attempted to treat the patient with an inhaled steroid, which is a mainstay of asthma control.
She insists she did nothing wrong. “I treated the patient here in my office and in three days the child was jumping around and was healthy,” she said, quivering. “Therefore, how they can criticize me? . . . I have been treating people for over 55 years the same way, and nobody died from respiratory problems or cardiac problems.”
The board wouldn’t relent, and this past May, Konopka consented to 14 hours of continuing medical education about asthma, pharmacology, and cardiology, in addition to the minimum required to renew a physician’s license.
Then Konopka was informed that the board had enough concerning evidence about her abilities to enact an emergency suspension of her license on Sept. 13. Instead of losing her ability to see patients within days, she decided to surrender her license, which would give her about a month to wrap up her practice.
Now, she wants her license back. She wants to figure out who is bringing what she calls this “fake charge” against her, and why. She wonders if it has to do with her antiabortion picketing outside Planned Parenthood, or her lack of electronic records, or the fact that she registered for but does not use the state’s Prescription Drug Monitoring Program, which is a way to curb opioid abuse.
She added it might be her age that led to the board’s disciplinary actions. “They got the idea that I am old enough to be forced to retire,” she said.
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The wooden chair in Konopka’s consultation room used to be reserved for patients. Now, it is often occupied by journalists. But she said that patients, too, are calling visiting, writing letters. “It is of course very painful because the patients are coming to my office, and calling over the phone, and crying, and waiting for me, and I cannot do anything about it,” she said. “I cannot refer to any doctors because they don’t want them.”
That was the argument she made in court three weeks ago. She was asking for an emergency injunction to get her license back, because her patients have too many “multiple chronic problems” for the “ACA system” to handle. The judge said he would take the matter under advisement.
“I am in limbo,” she said the following week. For a while after losing her license, she was still taking three swims every day in nearby lakes. But her last laps were on Oct. 23. She has knee problems, so she can’t walk her dog anymore. But she still drives him to back roads and lets him out of the car, then motors slowly through the trees, the dog padding dutifully behind.
She refuses to retire, though, or to wait passively for a verdict. A few weeks after her hearing, she’d had no news, and she was preparing for a confrontation, as she had with her ghost.
“I am planning to go to the superior court,” she said. “I have some kind of project.” She wouldn’t give any details on what she was hoping to do. “I am keeping quiet. . . . I am in a war with the people from the system, therefore I have to be careful with what I am doing — I don’t want them to come with a counterattack.”Eric Boodman can be reached at firstname.lastname@example.org. Follow him on Twitter @ericboodman. Follow Stat on Twitter @statnews.