House Call: Days Gone By
Many of us in private medical practice today struggle more to retain a sense of purpose and fulfillment on a day-to-day basis than we do to make proper and effective healthcare decisions on behalf of our patients. What should be a very clear mandate to expand our knowledge base and apply it every day to benefit our patients has become a secondary goal to the constant challenge of keeping our head above water amidst a growing torrent of confusing regulations and administrative responsibilities. And today, as I received a telephone call from my 84-year-old patient complaining of fever and swollen ankles, knowing that she would not be able to come to my office for evaluation and might end up in the ER in the middle of the night, I understood that the most important decision I would make the entire day was to make the effort to stop by her home at the end of the day to make a house call.
SAs a child growing up in a suburb of Boston, Massachusetts, I recall our family doctor, Dr. Gonnella, episodically ringing our front doorbell, being welcomed by my mother and grandmother into our home, accepting the offer of a seat at the kitchen table and a cup of coffee, and chatting casually about family and community. It was both satisfying and reassuring to see him… unless of course you were the sick child for whom he was called to make a visit! Nevertheless, I remember him–his towering presence, his authoritative but reassuring voice, and his white coat and small black doctor’s bag–because he was there for all of us in the house, to make us better, and to make us whole. His medicine of choice had less to do with a prescription pad than it did with a reassuring word, a pleasant smile, and a warm touch of the hand.
But such medicine is rarely seen today. The “house call” for most of us has been boxed and placed into the attic of healthcare, and relegated to fond memory for those of us old enough to remember its value. Most of us in private practice today measure the value of time spent caring for patients in terms of RVUs, DRGs, and ACO standards… complicated algorithms that may or may not serve to reduce the cost of healthcare, but most certainly and concurrently compromise the essence of healthcare itself. And there is very little room in this contemporary world of healthcare for the time and effort needed for house calls.
Not today. And not for me and my patient. Today, I made a house call, and brought to my patient more than a diagnosis, a prescription, and an invoice for services rendered. I brought to her love, compassion, and healing that will always transcend health insurance and federal regulation. For about an hour, the last hour of a long day, I was just a doctor caring for my patient in her own home… the same way that Dr. Gonnella cared for me. And it was just what the doctor ordered… for both of us.
Michael J Lucherini MD MS
Summit Medicine and Pediatrics