I am a Hospitalist and lament often that I just don’t feel that I truly grasp what really motivated the patient to come to the ED. In the past I had a practice where on Friday afternoons I would drive around doing house calls. The added context of witnessing a person within their home environment is so invaluable in understanding what makes people tick. I remember one instance where I could barely get inside the house due to stacked newspapers and dozens of cats present(boy did I ever miss that diagnosis 😏). It is sad that the modern medical world doesn’t realistically allow for these kinds of experiences anymore.
Bring a GP in a middle size town in north east Germany I regulary do house calls. It's the core of being a GP and all of my interns and Med students agree. GP is still the best job in the world and it is much more than just fixing illnesses and parameters, it's being part of the community. I' sure that it will be even more difficult to encourage students becomeing a GP, when we do not do house calls anymore. I don't know much about economics of GPs in the US but I'm quite sure that most of us can eat a Schnitzel from time to time. Do not let Economy ruin the center of being a doctor
What and wonderful column!! I cannot tell you how many certificates and awards I have seen at yard sales. People will buy them for the frames, but trust me, your family is not keeping all the crap that hung on your office wall. What you gleaned is priceless.
I've had my psychiatrist do house calls (to protect my privacy) - but his employer has banned them now, (probably due to concerns about boundary violations). So much of healthcare was better 50 years ago... nurses in hospital gave patients back massages and scrambled eggs for them...
Rush is fortunate enough to have a house call program (Rush@Home) and I’m fortunate to be a part of it half day per week. We see an average of four patients during those four hours. It is a complicated, difficult but rewarding.
Despite the good feels I am still not convinced of its overall effectiveness (but that could be related to my broader cynicism for the effectiveness of primary care). Regardless I am so grateful for the opportunity and do genuinely hope ultimately find a way to be sustainable in the modern health care system.
Thank you for sharing this story. Not many doctors will make house calls in my country Canada. I am blessed to have one that does and I am grateful for him to have managed my entire family’s care for years. I have so much respect for the medical profession and doing this is above the call of duty. Your article explains why those that do house calls continue to this day. Mad respect from Canada
I appreciate with & agree with your essay. I’ve also made a handful of house calls for the same reasons you list. One of the most meaningful was with a favorite patient of mine who was a retired RN, just like my Mom. She reminded me a lot of my Mom, which was always a comfort, as my parents were an 8 hour drive away from where I live. As it turned out, both Margaret and my Mom ended up with terminal cancers around the same time and at about the same age. I was able to see both of them multiple times in their last year of life. I was able to see both of them in their homes within the last few weeks of their lives & able to attend both of their funerals just before the pandemic shut everything down. That house call helped me find healing and work my way through the grief that came after they died.
After my dad's stroke it became impossible to get him into a car and his physician's office had a wonderful nurse practitioner who made regular home visits to manage his care. It made all the difference in keeping both parents in their home. Our local hospice also has a physician who makes home visits to homebound (not just hospice) patients. Invaluable services!
I suspect I became a physician in part from the experience of sometimes accompanying my father when he made house calls (usually I would be in the car with him for other reasons)
He was always energized after these visits even if they made him chronically behind in his other duties.
He had many many colorful stories to share of these visits. One I remember was him getting a call at 3 AM on a bitter winter morning from an elderly patient who was deeply worried that her sister was "looking poorly" and would he please come to see her. She showed my father to the bedroom through hallways stacked floor to ceiling with newspapers accumulated over decades . There he found a bed empty save for some twisted bedsheets and blankets.
"Oh that's right" his patient sighed,"she moved to California last year".
His joy of such encounters shapes my own sense of what it is to be a physician to this day.
It also enables the doctor to see the patient in an environment that is more comfortable for them than the medical office setting. Obviously, logistical factors will limit the amount of time one can devote to this. When I started practice with a small group in the late 1970s, two of the doctors had been in practice since the late 1940s and the third since the mid-1950s. They considered house calls to be just part of normal practice.
Over the years many of my patients have become friends. My hour-long online appointments leaves room for a lot of chit chat. And since my online direct primary care is based out of Southern California, many of my patients are nearby. But I've also had the pleasure of "seeing" a patient overseas because we both happened to be traveling to the same destination and he needed his care coordinated. It's a digital world now but it doesn't mean we have to forgo what still works best.
There is something to be said about the degree of worth implied by the doctor who is willing to go to his patient because he’s needed, and how the visit expresses that worth to the patient and the family. We do not feel valued by most of the people we come into contact with
I am a Hospitalist and lament often that I just don’t feel that I truly grasp what really motivated the patient to come to the ED. In the past I had a practice where on Friday afternoons I would drive around doing house calls. The added context of witnessing a person within their home environment is so invaluable in understanding what makes people tick. I remember one instance where I could barely get inside the house due to stacked newspapers and dozens of cats present(boy did I ever miss that diagnosis 😏). It is sad that the modern medical world doesn’t realistically allow for these kinds of experiences anymore.
Great discussion!!
Bring a GP in a middle size town in north east Germany I regulary do house calls. It's the core of being a GP and all of my interns and Med students agree. GP is still the best job in the world and it is much more than just fixing illnesses and parameters, it's being part of the community. I' sure that it will be even more difficult to encourage students becomeing a GP, when we do not do house calls anymore. I don't know much about economics of GPs in the US but I'm quite sure that most of us can eat a Schnitzel from time to time. Do not let Economy ruin the center of being a doctor
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What and wonderful column!! I cannot tell you how many certificates and awards I have seen at yard sales. People will buy them for the frames, but trust me, your family is not keeping all the crap that hung on your office wall. What you gleaned is priceless.
I've had my psychiatrist do house calls (to protect my privacy) - but his employer has banned them now, (probably due to concerns about boundary violations). So much of healthcare was better 50 years ago... nurses in hospital gave patients back massages and scrambled eggs for them...
Rush is fortunate enough to have a house call program (Rush@Home) and I’m fortunate to be a part of it half day per week. We see an average of four patients during those four hours. It is a complicated, difficult but rewarding.
Despite the good feels I am still not convinced of its overall effectiveness (but that could be related to my broader cynicism for the effectiveness of primary care). Regardless I am so grateful for the opportunity and do genuinely hope ultimately find a way to be sustainable in the modern health care system.
Very well said. I am a retired 77-year-old family physician, and I also occasionally enjoyed making house calls.
Thank you for sharing this story. Not many doctors will make house calls in my country Canada. I am blessed to have one that does and I am grateful for him to have managed my entire family’s care for years. I have so much respect for the medical profession and doing this is above the call of duty. Your article explains why those that do house calls continue to this day. Mad respect from Canada
I appreciate with & agree with your essay. I’ve also made a handful of house calls for the same reasons you list. One of the most meaningful was with a favorite patient of mine who was a retired RN, just like my Mom. She reminded me a lot of my Mom, which was always a comfort, as my parents were an 8 hour drive away from where I live. As it turned out, both Margaret and my Mom ended up with terminal cancers around the same time and at about the same age. I was able to see both of them multiple times in their last year of life. I was able to see both of them in their homes within the last few weeks of their lives & able to attend both of their funerals just before the pandemic shut everything down. That house call helped me find healing and work my way through the grief that came after they died.
Thank-you.
After my dad's stroke it became impossible to get him into a car and his physician's office had a wonderful nurse practitioner who made regular home visits to manage his care. It made all the difference in keeping both parents in their home. Our local hospice also has a physician who makes home visits to homebound (not just hospice) patients. Invaluable services!
I suspect I became a physician in part from the experience of sometimes accompanying my father when he made house calls (usually I would be in the car with him for other reasons)
He was always energized after these visits even if they made him chronically behind in his other duties.
He had many many colorful stories to share of these visits. One I remember was him getting a call at 3 AM on a bitter winter morning from an elderly patient who was deeply worried that her sister was "looking poorly" and would he please come to see her. She showed my father to the bedroom through hallways stacked floor to ceiling with newspapers accumulated over decades . There he found a bed empty save for some twisted bedsheets and blankets.
"Oh that's right" his patient sighed,"she moved to California last year".
His joy of such encounters shapes my own sense of what it is to be a physician to this day.
It also enables the doctor to see the patient in an environment that is more comfortable for them than the medical office setting. Obviously, logistical factors will limit the amount of time one can devote to this. When I started practice with a small group in the late 1970s, two of the doctors had been in practice since the late 1940s and the third since the mid-1950s. They considered house calls to be just part of normal practice.
Over the years many of my patients have become friends. My hour-long online appointments leaves room for a lot of chit chat. And since my online direct primary care is based out of Southern California, many of my patients are nearby. But I've also had the pleasure of "seeing" a patient overseas because we both happened to be traveling to the same destination and he needed his care coordinated. It's a digital world now but it doesn't mean we have to forgo what still works best.
There is something to be said about the degree of worth implied by the doctor who is willing to go to his patient because he’s needed, and how the visit expresses that worth to the patient and the family. We do not feel valued by most of the people we come into contact with