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, audible everywhere. She thought it might be coming from the neighbors’ — but no, it was clearly inside her own walls. “Mrs. Ghost,” she called it.
Of course, 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 that she was bothered by ghosts. But finally, one night around midnight, as she was getting ready for bed — there it was, in her room, a few feet away, 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 an official complaint about her, she drove over to find out their motives herself. And in early November, after she voluntarily 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 next door to her house, with no receptionist, no practice administrator, no nurses, no N.P.s, no P.A.s, no hospital affiliations. She has a computer in her kitchen, 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 office visit.
Against her will, though, she has also become the face of a related debate about how best to ensure that older doctors are providing the most 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.
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 they’re 40. Yet many 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.”
To see Konopka, you drive past a trout-filled lake, along a country road, until you see a mailbox with a little sign that reads “A. M. Konopka, M.D.” Her black labradoodle greets you in the yard with growls, and 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 in her examining room, 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, bright as a Froot Loop, resting on the “Physicians’ Desk Reference,” its binding a deep, serious blue. 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 the small city of Rzeszow, about 60 miles from Ukraine in one direction and Slovakia in the other. But by the time she was graduating high school, her family had moved to Krakow, 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 after that. But her dressmaker made a prediction: Don’t be upset, she said. If you wait long enough, you’ll get in.
Konopka smiles at the memory. It was a good prediction, she said. She waited three years, cleaning out laboratories, practicing piano. Then, after Joseph Stalin died in 1953, the Polish government became a little more forgiving — an extension of the Khrushchev Thaw — and Konopka started medical school. “My professor from internal medicine was always telling us, ‘You have to know medicine to take care of people in jungle or desert,’” she said. “I can really take care of any sickness.”
“This is one of the big questions in the field of medical education: What should we be requiring of older doctors … to practice medicine?”
Dr. Anupam Jena, Massachusetts General Hospital
Then, when she came to the United States in 1961, she had to prove her competency again, writing exams, doing residencies and internships, getting licensed in two different states.
The paperwork was a pain, and some of the hospitals that employed her were in rough parts of New York, but practice-wise, she doesn’t remember any problems. She saw patients at St. Catherine’s Hospital in Brooklyn, and Misericordia Hospital in the Bronx, and Jersey City Medical Center, in New Jersey, to name a few. Eventually, she moved to New Hampshire, where the mountain 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.
The complaints, she said, began three years ago: complaints about her prescribing practices, about how and when she referred patients, about her diagnoses. She said they came from other local providers.
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 in with a heartbeat that was too fast and strangely patterned. According to documents from the New Hampshire Board of Medicine, 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.
She rejects the idea that she has done anything 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 know medicine, I know pharmacology, I know everything. I have been treating people for over 55 years the same way and nobody died from respiratory problems or cardiac problems of any age.”
The board disagreed, and tried to arrange a hearing in 2016. It was rescheduled twice. Finally, 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.
But then Konopka was informed that the board had enough concerning evidence about her abilities as a physician to enact an emergency suspension of her license on Sept. 13. Instead of losing her ability to see patients — at least temporarily — within days, she decided to voluntarily surrender her license, which would give her about a month to wrap up her practice.
Now, she is trying to get her license back. She wants to figure out who is bringing what she calls this “fake charge” against her, and what their true motive is. She wonders if it has to do with her anti-abortion picketing in front of 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 also believes that the local hospital has been trying to steal her patients for years.
Or, she went on, 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. “But I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”
“I don’t want to retire. It doesn’t matter my chronological age: I can work right now for another 10 years.”
Dr. Anna Konopka
There has been plenty of controversy about how to keep doctors plugged in to the latest debates and constant updates in medical knowledge. In 2015, for instance, physicians revolted against the American Board of Internal Medicine’s proposal for more stringent mid-career testing, complaining it was burdensome, expensive, and irrelevant to patient care. That’s still a point of contention — especially for those who might be nearing the age of retirement.
“There is no point in designing an intervention that is cumbersome to physicians if we have no proof that it improves their outcomes,” said Jena, of Mass. General. “These things are big enough and important enough for patients that we should be trying to generate high-quality evidence.”
Jena has done research looking at how the age of a treating physician in hospitals correlates to inpatient outcomes. His team found that older internists tend to have higher mortality among their patients. But that finding does not tell you anything about a particular physician; it just shows that doctors and their employers as a whole need to consider how to keep practitioners sharp and up to date.
In Konopka’s case, it’s hard to know how seriously to take her conjectures about why her competency is being questioned. The medical board declined to comment beyond the documents that have been made public.
“Sometimes, as in any other industry, decisions about physician termination are made in good faith, and sometimes physicians have brought and won lawsuits for antitrust violation, breach of contract, or if you’re dealing with a state agency, a failure of due process,” said Judith Feinberg Albright, a health care attorney who has no involvement in the Konopka case. She added that it might be harder and costlier for a physician in solo practice to engage in corrective action than it would be if he or she had the support of administrators and partners.
Some of Konopka’s patients — whose phone numbers she provided to STAT — have not yet taken on other primary care providers, hoping that she will get her license back. Cheryl Hodgdon, a 56-year-old dog trainer from Croydon has not had such a strong attachment to a physician since she stopped being treated by the doctor who delivered her. She had an appointment with Konopka once a month. “She believes, like a lot of old doctors from Europe, that the less medication you take, the better. I love that about her,” said Hodgdon.
Hodgdon also loved the recipe for a honey-and-garlic elixir that Konopka gave her for a cold last winter. She loves that Konopka always picks up her phone, no matter what. She loves that Konopka will send patients to get Olbas Herbal Remedies from the pharmacy. And she agrees with Konopka that American-trained doctors might not want that kind of practitioner in the area.
As Hodgdon put it, “She’s different. She’s on her own. She’s not controlled by any hospital; she can talk to you for as long as you need her to.”
The wooden chair in Konopka’s consultation room used to be reserved for patients. Now, it is often occupied by journalists. They come with recording devices and cameras and computers, snapping pictures, asking for documents.
But she said that her patients, too, are calling and visiting and 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 Merrimack County Superior Court in Concord, N.H., 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. She added that they cannot afford care from anyone in the area but her. The judge said he would take the matter under advisement.
“I am in limbo,” she said the following week. For a while after she lost her license, she was still taking her three customary swims every day, driving to Lake Sunapee or Pleasant Lake, doing a quarter-mile at a time. But she did her last laps of the season on Oct. 23, when the water temperature, she said, was 61 degrees. She still takes her dog out to wooded back roads every day. She has knee problems, so she can’t walk him anymore, but she lets him out of the car and motors very slowly through the autumn trees, with the dog padding dutifully behind.
She refuses to just retire, though, or to wait passively for a verdict. A few weeks after her temporary hearing, she’d had no news, and she was preparing for a confrontation, as she had with her ghost.
“Friday 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. If you are in war, you have to be careful about your enemies. 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.”