House calls: A timeless practice
Michael Good, MD, Family Physician
ProHealth Physicians, part of OptumCare®, is a physician-led medical group caring for more than 345,000 patients with 350 primary and specialty care providers at 85 locations in Connecticut.
Well into my career as a primary care doctor, I had an encounter that changed my practice for the better. In February of 2015, after a snowstorm, an elderly patient whom I had cared for over twenty years came into the office for a blood pressure check.
My patient was frail, with severe knee arthritis, and needed a walker to ambulate. He, his son, and his daughter-in-law seemed flustered when I came into the exam room.
They described to me how in order to get from their house to the appointment; they had to lift my elderly patient up by his armpits and with great difficulty carry him over a snowdrift.
I was aghast, “All this for a blood pressure check?” I thought to myself. I decided that from then on he would be having his check-ups at home.
Since that visit, I’ve been keeping my eye out for patients who physically struggle to get to the office. For the patients that need home visits, I spend Wednesday mornings traveling to their homes, making 2–3 calls before coming in to the office for the afternoon.
I allow myself an hour for travel time and the visit. This schedule lends an un-rushed feeling to the appointment. The intimacy of the home, and seeing pictures of my patients from years past illuminates their life story.
Many patients recall wistfully days in the past when doctors often made house calls. The fact is, visiting their homes today reveals a trove of helpful information.
The home visits allow me to understand my patients in a human way and brings to light the barriers they face in their effort to care for themselves in a home where they have lived for decades.
Prove value to leadership
I like to start my visit by asking my patient where in the home they’d be comfortable sitting. A place is picked out, and after a few visits, this becomes a ritual.
One of my favorites is the home of an elderly woman who chooses to sit on her sunporch overlooking the surrounding fields; it’s a beautiful setting for a doctor’s visit.
The first time I visit a particular patient, I do a home survey. There’s a lot to learn walking around the house. I look at the bedroom and check the path to the bathroom they use at night. Is it clear and well lit?
Are there grab bars by the toilet and shower? I look at the floors of the halls and rooms they travel. Are they clear of trip hazards? Are throw rugs present?
If they’ve been losing weight or if money is tight, a trip through the kitchen shows whether there is food in the pantry and refrigerator.
After a patient’s return from the hospital or a nursing home, I have them show me where they keep their medicines and tell me how they take them.
At transitions in care, there are many opportunities for medications to get duplicated, dropped, or confused in a seemingly endless variety of ways. What is on the patient’s kitchen table rarely matches the chart in the office.
The in-person, detailed medication reconciliation permitted by a house call has helped me solve diagnostic puzzles.
Once I discovered a persistent, mysterious case of diarrhea was due to a pharmacy error — the pre-packaged medication packs she received were giving my patient several laxatives a day!
What’s good for the patient is good for the doctor
We typically see progress as moving ever forward; especially at the pace technology has changed our world. Conversely, we see the past as a place that we shouldn’t return to.
However, by returning to the longtime traditional role of a physician on a house call, I have recovered a great deal of the joy of being a doctor.
The benefits to patients are plain: convenience, reduced travel burden and an attention to details of their clinical profile that is hard to see from within the walls of the clinic.
For practitioners, house calls are a way to rediscover the sense of purpose and human connection that first inspired us to become clinicians. House calls allow warm, friendly and trusted relationships to thrive between patients and physicians.
Recently one of my patients wrote on his patient satisfaction survey, “I am disabled and Dr. Good came to my house for my appointment. I will be forever grateful for that. What doctor does that these days?” Comments like this mean a lot to me.
I became a doctor to practice medicine and positively impact people’s lives — no matter where the care takes place.
I have found that all the harried aspects of modern medical practice; the metrics, the boxes to check, the EHR clicks that encumber our work in the office day in and day out are gone during a house call.
The human essence that lies at the heart of medical practice is reinforced when we visit a frail patient in their home. These visits rejuvenate me, and if you pick a patient or two to start seeing at home, I’m sure you’ll love the experience too.
This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice.