The number of docs is deficient
Though the need would appear quite sufficient
If you ask me why is it?
I’ll say a home visit
In the end remains inefficient.
Synopsis: I’m a family practitioner from Sioux City, Iowa. On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places. I just got back from a six-week assignment in Barrow, Alaska, the northernmost point in the country.
My father made house calls.
He graduated from medical school sixty years ago, when women were systematically excluded from the profession. At that time, a physician finished an internship, hung out a shingle, worked solo practice, and took call 24/7/365. He made hospital rounds in the morning, saw patients through the day, and, after supper, made evening rounds and house calls.
Our 1960 Ford Falcon had a spotlight, like the police used, so he could see house numbers at night.
He used to take me with him, to the hospital and to patients’ homes, when I was in elementary school. I waited in the front lobby of the hospital at a time when it constituted the main ingress, but I got to go into houses with him. I remember the time spent with him, I don’t remember the time spent waiting. I can see his stethoscope hanging by the front door, his electrocardiogram machine in the back seat, and his doctor’s bag with the blood pressure cuff and medications like Demerol , penicillin, and digitalis.
But in an era of generalists, my father specialized first in Internal Medicine, and then in Cardiology. ICUs and CCUs didn’t exist, and before revascularization, statins, and beta blockers, patients with heart attacks frequently received treatment at home. Looking back, hospital care at the time differed little from a doctor making a home visit.
I have done house calls, but I probably don’t do more than twenty a year.
When I worked for the Indian Health Service in New Mexico, the government tore down a perfectly functional clinic and paid me to do nothing until the new clinic was built. After two weeks I realized I had started to be mean to my kids and I hijacked the Community Health Nurse to take me on hogan visits. I learned a lot about my patients I wouldn’t have otherwise known.
Mostly, when I care for a patient in the home now, I do so more for my convenience than for the patient’s.
Once, when a heavy, wet snow closed the city and the clinic down in the middle of the day, I got a page from a patient with bad lungs, heart, and balance just as I was about to exit the building. In the days before common use of cell phones, I turned around, shucked off my parka, and returned the call. After a brief conversation, I knew I lacked certain key items of information from the physical exam to make a good clinical decision, and I didn’t want to endanger the patient by making him go to the ER in bad weather. I asked the address, and saw that the patient resided between my clinic and my home.
I arrived fifteen minutes later on roads I could only negotiate with four-wheel drive. Fifteen minutes after that I asked for a towel as I washed my hands at the kitchen sink, grateful for the warmth of the water and a ritualized end to the visit.
Today, I talked with a friend and patient who lamented the absence of my house calls. We talked about how inefficient such delivery of care is, and how we don’t have enough doctors to make the service available on a regular basis.
It’s rare that I do house calls now. Documentation suffers the longer one waits to make one’s note. Still, I have a dedicated stethoscope and otoscope in my car.
But I don’t carry a black bag with Demerol, digitalis, or penicillin.
Tags: blood pressure cuff, clinic, Community Health Nurse, Demerol, digitalis, electrocardiogram machine, Ford Falcon, four-wheel drive, heart attack, hogan, home visit, house call, Indian Health Service, penicillin, spotlight, stethoscope