House calls can offer insights and create opportunities that are not possible in the office. Go for it when you can!
During my few house calls in medical school, I thought it was a special window into how medicine worked in the past and never considered that I could have a career as a house calls doctor. As my interest in geriatrics developed, I came to appreciate that house calls encapsulated why I chose to dedicate my career to geriatrics—being on the front lines of care for those that are in great need, managing medical complexity, and seeing the person as a whole human being (or even more, a microcosm an entire human system).
Introducing learners to house calls
When I get the opportunity to introduce learners to house calls, I try not to paint the picture of a quaint house call doctor as a relic from the past. House calls are an effective and creative care delivery update that may be the only way some patients can access outpatient medical care.
Similarities between house calls and office-based care
On a learner’s first few house calls, I emphasize the similarities between house calls and the office-based care most learners are familiar with, I say that besides the different setting, we do all the same things: gather history, perform a physical, we can even order in home testing such as blood work, EKGs, and some imaging tests.
Differences between house calls and office-based care
Once a learner is comfortable with the idea of performing a visit in the home, I change my approach. I emphasize just how different and unique home-based medicine is from office-based practice. House calls have a different flow, the visits are longer, and the patient retains more control. Access to information—particularly about the family dynamics, environmental hazards, caregivers, and medications—is much richer than in the office. Other information such as specialized testing (DXA scans, CT scans), and visits to specialists are generally unavailable. Because of these differences, management of certain conditions is quite unlike office-based practice.
Home-Based Medical Care for Older Adults is a clinical casebook put together by experienced interdisciplinary house call practitioners from around the US describing how they handle commonly encountered medical issues. Each case walks the reader through the clinical decision-making process for management.
If you are an office-based provider, here are a few circumstances in which you can consider embarking on a home-based visit:
1.)Your patient has been missing multiple appointments because coming to the office puts an undue burden on them or their caregivers.
2.)You have questions about whether the medications or disease self-management protocols you have prescribed are being implemented.
3.)You have concerns about the home environment or level of caregiver support.
4.)You are providing end-of-life care and the patient must remain home for comfort.