In a world of HMOs, skyhigh medical costs, specialists who don't treat the whole person, and truncated office visits, Fort Davis family practitioner Dr. Luecke may sound like an anachronism -- or an idea whose time has come around again.
Some days, his commute is over 100 miles between three towns; he's gone 120 miles just to make a house call. He's been paid in haircuts for a C-section. He does everything from removing bullets to delivering babies. He's hardly ever off-call. But, it all comes with the territory -- a mighty large one, hundreds of miles square, dotted with small towns, in the Big Bend country of West Texas -- and he wouldn't have it any other way.
"Family practice is one of those professions where you get to work with the whole family. I like to be right in the middle," says Dr. Luecke. "There's variety… especially out here, you get to do a little bit of everything."
Helping people is why Dr. Luecke got into medicine in the first place. "You're making a difference in people’s lives. I feel like I’m helping them. I always said that I went into medicine because it was the most direct and productive way of helping folks."
Dr. Luecke had considered law at one time. "My father was a lawyer and my mother wrote for a newspaper and they both seemed like they were helping folks. The legal system is based on justice and the system eventually helps people, it balances out. With the newspaper, you write about different things and sometimes you help people out with your articles. But it seemed to me that medicine was a way you could do that just about all the time. I was pretty good in math and science, but it wasn’t really the academic interest as much as the people interest."
A native of Wichita Falls, Texas, Dr. Luecke's roots in the state run deep (his maternal grandfather, E.M. Davis, of Brownswood, served in the state senate in the 1930's). However, Dr. Luecke ventured far from home for his medical training. He received his undergraduate degree in Human Biology from Stanford University in California in 1980, his M.D. from Southwestern Medical School in Dallas, and then completed an internship (which included three years of family practice and a year of general surgery) in Spartanburg, South Carolina. An interest in family practice was clinched by an externship in Alpine, Texas, under family practitioner Bart Pate. (Pate has since gone on to teach family practice at John Peter Smith in Fort Worth.)
It was a synthesis of location and occupation that made him establish his practice in Fort Davis thirteen years ago. He says the area has changed only slightly since he was a child. "We used to take family vacations here. It always reminded me of the Old West in a lot of ways. My mother used to describe Indians behind the cliffs as we drove to Fort Davis. The Indians always had a magic in that area." As did the art of family practice. "Because it’s isolated here in a lot of ways, a family practitioner is doing a lot of different things." His is a varied practice which includes obstetrics, pediatrics, and some surgery such as vasectomies, appendectomies, hernia repairs, and breast biopsies. He even does a little bit of psych work ("whatever is needed").
His favorite aspect of the job is obstetrics. "It's such a rush every time a baby is born. Sometimes the surgery part is kind of fun. Sometimes setting bones is kind of fun. Taking a bullet out -- I always felt like Doc on Gunsmoke, -- 'Give me a pan [he acts like he's spitting in a pan] PING!' But mostly it's the obstetrics I like. Out here, it's still the family practice guys who deliver babies."
The small town life suits Dr. Luecke well. He lives in a log cabin outside Alpine, on a plot of land so big he had room to build his own baseball field, complete with a little homemade wooden sign "Field of Dreams" on the gate. He has played on and sponsored various adult softball teams and coached his oldest daughter's teams.
Most people have only tangential experience with small town family doctors through movies which depict doctors frequently getting paid in livestock. The myth is steeped in truth -- Dr. Luecke is no stranger to bartering. He once traded an appendectomy for a new engine for his truck; another time he traded a C-section for haircuts. "The girl's now about seven years old and I'm still getting free haircuts. When you think about that, I'm getting a good deal in the long run."
Another throwback -- he actually makes house calls. Not only is it a convenience for the very ill, it gives him more insight into his patients. "House calls are a good way to see what people don't tell you, what it's like at home, what they're proud of. I was over in Marathon; I supervise a rural health clinic so I'm there once a week. I walked into this lady's house and her wall is lined with pictures of her family, solid pictures on the wall. And you realize how important family is to her. There was another lady; I'd check on her and I'd have to wade through the vodka bottles and the beer cans and stuff. You don't know that a lot of times unless you go to somebody's house."
 
With rural health clinics in Alpine and Marathon to supervise in addition to his practice in Fort Davis, Dr. Luecke spends a lot of time shuttling between Big Bend towns. "Usually, I get up in the morning and make rounds at the hospital (in Alpine) and then go to Fort Davis. And then I come back in the evening and make rounds on the way home. On Wednesdays, I take my call from the ER, which is the day I usually do my procedures, so I usually stay in town. Thursday mornings, I go to Marathon, and then in the afternoon, I go to Fort Davis. Which makes for a long trip, because I have to go 30 miles to Marathon and 30 miles back to Alpine, then 25 miles to Fort Davis and then 25 miles back to Alpine. But it's not the L.A. freeway, it's a nice drive."
Dr. Luecke says his hiring of nurse practitioner Pam Dalzell about six months ago has been well received. As the OB practice picked up and he was frequently getting called away to the hospital, he found himself running late a lot. "I thought, 'Well, if I'm not able to be on time, I can find somebody who can be on time.' And the other thing is, a lot of women like women practitioners. That's the thing now. As hard as I try, cross-dress or whatever, it doesn't work," laughs Luecke.
Practicing medicine in a small town is a good news/bad news proposition for the doctor, but one which the patient always wins. "The thing about a small town, you're always going to see people that you've operated on and when you've done things well, that's good and if you haven't done things well, you're always going to see it," laughs Dr. Luecke. "I think there's a sense of accountability in a small town."
Dr. Luecke also says confidentiality is of the utmost importance in a small town. "Whatever's said at the office stays at the office. You have to respect confidentiality because talk gets around real quick in a small town if you start violating confidentiality." However, he notes, he's never really off-call. "If you're in town, unless you check out, then they call you if it's your patient. And that's one of the hard things about a small town -- you're never really off, unless you check out."
Dr. Luecke never loses sight of his reason for getting into medicine in the first place -- not for prestige or a fancy house or a garage full of Mercedes -- but his desire to help people in the most hands-on way possible. "I think that the most important thing for a family practitioner nowadays is to be an advocate for your patients. I hope that I would be compassionate and competent, but especially to be a good advocate for them," says Dr. Luecke earnestly.
"If I don't find the problem, I'll find somebody that can find the problem. I'll do whatever it takes to try to get you well, to try to steer you in the right direction. I think that's important nowadays because people have specialized so much it's kind of like, 'I only do this, have you got another problem? Not my area, sorry. I just do the left nostril, you know.' I think that's what makes a family practitioner unique, particularly in a small town. I think if you're a good advocate, you're saying, 'Well, I'm going to try to get this guy squared away, help him in any way I can,' then I think that's the best kind of doctor that you can be."
And the people of Big Bend couldn't agree more.
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