The Physician House Call: A Lost Art?

As my day started today, a quick glance at the schedule showed that I would very likely be getting home late yet once again. The morning was a full schedule which kept me busy well until lunchtime. The afternoon was 80 percent full with the last two patients of my day listed as being house calls. A quick e-mail to my wife informed her that I would be a little late this evening - yet again.

After nine years of private practice, I still provide to my patients what I feel is full service family medicine services. The first 30 minutes to 60 minutes of my day is spent on the hospital floor seeing inpatients and providing acute care for my hospitalized patients. Office hours start promptly at 8 a.m. and I typically spend my lunch hour catching up from the busy morning schedule. Signing off on lab reports, x-ray studies, correspondence from consultants, and finishing up discharge summaries keeps me very busy while the staff is at lunch. I typically finish my morning chores with just a few minutes to spare before patients are brought back for the 1 p.m. appointments.

Why do I keep such a busy schedule? I feel that the services I provide to my patients not only helps to keep them healthy, but very satisfied with their choice of our practice for their primary-care home.

I choose to provide in-home services for my patients that are not able to easily come to the office. I do not see my healthy or able-bodied patients at home. Rather, I choose to see my patients at home that cannot afford the high cost of ambulance transportation to the office for non-emergency services. Insurance companies and Medicare do not provide a benefit for EMS transport for routine primary-care services. Instead of requesting my shut-in patients to present to the office, I will stop by their homes on my way home and provide services for them.

I saw two patients on the way home today. The first patient has end-stage corticobasilar syndrome and is barely able to ambulate through his home without assistance. I do not know how long it has been since he has left his home, but I do know that his family very much appreciates the fact that I see him in his home. Providing in-home services allows the physician to get a first hand observation of our patients' living conditions. My particular patient also has severe osteoarthritis and requires bilateral knee injections at least every four months in order to allow pain relief. After finishing his visit and providing his knee injections, the family and caregivers thanked me for taking time to come and see him. Not only am I able to continue providing his care, but I am able to prevent him from spending close to $1,000 for a round-trip ambulance transport, prevent his daughter from having to take a half-day off from her job, and prevent him from feeling uncomfortable while being rolled into my office on a stretcher.

My second home visit was a patient with recurrent rhabdomyosarcoma of the groin. Unfortunately, he is now admitted to home hospice and is barely able to move from his hospital bed to a bedside toilet. His wife and daughter are providing excellent care for him. As I sat by his bedside reviewing his medications, vital signs, dietary information, etc., his family echoed their high satisfaction for the home services provided. This patient, if he was asked to come to the office, would also require expensive EMS transport and would also feel very uncomfortable on the stretcher being wheeled past others in my office to the exam room.

In residency, we were not required to make house calls for our patients. I can honestly say that I do not recall the art of the house call being taught to me by any of my attendings. Rather, I have adopted my own style for conducting house calls and the medical students and residents that rotate through my office are also encouraged to accompany me on home visits. Most of them are surprised that I make house calls, however after each visit has been completed, each student and resident have relayed to me that they feel the services provided are very much needed and are unfortunately a neglected portion of current medical education.

I practice in a very small town. My patients that I visit at home were once very reliable and happily came to the office for their follow-up visits when they were so able to do so. Now that their medical conditions have advanced to the state that leaving their homes is a very difficult task, they are very appreciative of the service provided. Word has spread over the past few years of my routine of making house calls. Not only has it allowed me to continue to provide care for our shut-in patients, but it also continues to produce extremely high patient satisfaction scores and the ever-so-important word of mouth recommendation for our practice. If you are currently not offering house calls as an extension of your services provided, doing so is certainly worth considering.

Even though the day can be long, the satisfaction you will gain as a result of providing the service is invaluable.

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