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Demystifying Medicine One Week at a Time

House Calls

Beginning in the 1970s, the house call began a slow death. As the medical-industrial complex (MIC) burgeoned, with bigger hospitals and a surfeit of technology, it became incumbent on patients to come see us rather than us going to see you.

Yet there are pockets of house calls still left in the U.S.

For the geriatric age group, there has been growth in the care-at-home sector, especially for homebound elders. They can get not only doctor visits, but nurse visits, wound care, physical therapy, intravenous medications and nutrition, all kinds of medical equipment, and even x-rays at home. To meet the needs of our growing geriatric population, many doctors have chosen to work for agencies that provide in-home care to elderly patients, avoiding the sterility of the office environment.

Many geriatric training programs require their trainees to perform house calls. Whether residents and fellows like the experience or not, no one can deny that seeing a patient in his or her home environment provides a much richer and fuller picture of a patient than seeing them in an office or hospital setting.

Of course the rise of concierge medicine has spurred growth in the house call field. Concierge medicine involves paying an annual fee to put your doctor on ‘retainer,’ so that you can stay in their practice. Paying the fee in theory gives you unfettered access to the doctor, including being able to reach your own doctor 24/7 via direct cell phone access.

A concierge doctor might not only make a house call, but might accompany you to see a specialist and act as your advocate. A concierge doctor has time to do this since usually 90% of their patients opt out of paying the retainer so the doctor has more time to spend with the remaining 10%.

Of course, house calls have never truly gone away at the luxury end of the spectrum. Private physicians have always been willing to deliver customized care to patients in their homes, on tour, or in hotels, for the right price. See Dr. Murray, as in Conrad.

When I was a chief resident, I moonlit for an outfit that provided house call service to hotels in major metropolitan areas. I found out about it by answering an ad in the New England Journal of Medicine. I think it was a spirit of adventure and my latent literary sense that this gig would provide some interesting stories. I did meet some noteworthy characters during my time in the field.

“What kind of medicine can you actually practice in a hotel room?”

I asked the same thing, but as I gained more experience, it became clear: Mostly it was about offering reassurance to weary travelers. Feeling sick in a strange city, people calling our service were grateful and appreciative of a medical presence who could hear their story and offer solace. They paid dearly for the privilege, but the vast majority thought it well worth it.

Now that health care reform has passed, and Medicaid and Medicare will expand to their largest enrollements ever, I wonder if house calls will be included in the ‘experimentation’ phase of the law, or whether they will remain relegated to the fringes of the medical establishment.

As a patient, I’d love to be seen in the convenience of my own home by a doctor who had the confidence to practice without all the whistles and bells of modern medicine.

5 Comments

  1. I suspect that general practice, family medicine, and geriatric care can be partially or wholly done in a home or residential setting but not specialty medicine which requires lots of specialized equipment, various trained personnel, etc. Home visits in a small town make sense; in a large city with issues of travel distance, travel time, safety, I’d have my doubts. When I was a kid I remember Dr. Sahlmann, gratuate of the medical school at Heidelberg, visiting. He was a refugee from the Nazis.

  2. Very interesting posting! House calls are also popular in some communities where cultural practices keep patients from going out. When my son Jake was a baby, we chose a pediatrician for him in San Francisco who spoke Chinese so Jake’s dad could communicate with the doctor and his office staff. After Jake was born and the pediatrician examined him in the hospital, he said he would come to our house in two weeks. For the 2 week well baby appointment (in 1998, there was no 5 day appointment), Dr. Quock made house calls because 90% of his patients were Chinese and they observed “man yue”, the Chinese custom of mother and newborn staying inside for the first month postpartum. He said if he didn’t do housecalls, his patients wouldn’t make their 2 week appointments. I have to say it was nice to have him come to our house. He brought a scale and tape measure, examined Jake for jaundice and all the other things pediatricians do during the 2 week well baby visit. When my second and third babies were born in Chicago, I kind of missed having a house call for that first appointment after leaving the hospital.

    • glasshospital

      March 29, 2010 at 2:59 pm

      Susan: Thanks for sharing this wonderful story. A great example of a medical provider making the system work for the patients by respecting cultural norms. A house call with a newborn would be so much more convenient for the Mom and the family.

  3. Great post. Another segment of healthcare where house calls still exist is midwives. I had two home births with a CNM. Each time, the CNM and her coworkers did one of my last prenatals at home, attended the birth at home, and then visited my house every other day after the birth for the first week to ensure that baby and I were fine and breastfeeding was going well. We mixed one of the last home visits with an invitation to stay for dinner, which the midwife accepted. It’s great to get to know medical providers as people rather than just clinicians.

    The same family heath and birth center where my midwives worked had a general practice doctor on staff who provided care for my whole family, and while he didn’t do house calls, he did give us his home phone number and told us to call anytime if we really needed him. Now we’ve moved to a different city, and we can’t find anyplace as amazing as our old clinic, where everyone knew every member of my family by name.

  4. I don’t understand why Dr. office’s are so rude when asked how much will an office be if I am paying cash?? What is wrong with government currency?!

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