What I learned as a house call physician


As doctors, we simply want to spend more time with our patients. As a doctor for 13 years, and someone who now recruits doctors as a large part of my job, I’m witnessing the battle for more time with patients wage on, but there are no winners. Patients are waiting longer for hurried appointments. We spend more of what little time we have, prescribing and referring out because we’re racing to meet minimum visit numbers. Time is at the crux of so many of the issues we see in primary care, and throughout the care continuum.

In taking time with our patients to educate them, listen to them, connect with them, we can prescribe less, refer less and act as the primary source of care. This is an issue we’ve wrestled with a modern day medicine, and is not as impossible to fix as some may think. As a nephrologist, I have cared for patients who dialyze at home. I’ve witnessed firsthand how peritoneal dialysis patients live a longer, more comfortable lives than those who need to leave the home for treatment. The medical benefits of this flexibility and self-sovereignty are clear and observable.

In that vein, I’ve transitioned to seeing most of my patients in their homes and have witnessed how transformative house calls have been. This is true not only for the lives of my patients, but also for me, a working physician mother. It’s time to admit that there’s nothing magical about the four walls of an office. In fact, those walls might be hindering the compassionate, personalized, comforting care patients need.

Most instances when I’m doing house call visits, within the first five minutes, I have learned so much about my patient. The fact that they’re on their own turf makes such a significant change in their comfort level. Being in their home environment communicates this patient’s circumstances and how I can adapt my care plan to fit his or her needs, without the patient saying a word.  In 25 minutes, I’m learning everything about this person’s lifestyle and understanding decisions that must be made and it’s a more effective use of my time and theirs. We have the space to discuss their chief issue at that moment, and I have the opportunity to discuss other things I’ve observed that are being ignored. Ignored, of course, because no one doctor had time to ask.

I recall a young patient who is unemployed and a diabetic. She’s been scared and confused for years because her previous doctors rushed through visits, and she’s never developed a relationship with any primary physician. She admittedly isn’t compliant to the health regiment she’s been prescribed in the past due to these circumstances of inattention and lack of clarity on cost. Education, training, and relationship-building are necessary for her and other patients in similar predicaments where they simply need support. This has been lost in our current system.

The traditional doctor’s office, along with its accompanying costs, should no longer dictate how all primary care is delivered. Patient minimums, paperwork, administration, and other adjacent tasks create an environment nonconducive to empathetic care. On the other side, our patients are waiting upwards of twenty days for an appointment. This delay is followed by more waiting, germs, more waiting, a quick appointment, and it’s done. Fundamentally, patients are not extracting the value and education they need from doctor visits in the traditional clinic setting.

If we keep failing at primary care, kicking the proverbial can further and further down the road, we’ll eventually run out of road. Rather than getting to the end of that road and having to backtrack and correct our mistakes, we need to focus on doing things right the first time.  Doctors are frustrated and currently in an impossible situation, as are our patients. The bottom line is when we do things right the first time, and provide unhurried, personalized, compassionate care, we’re all better off. The house call is the answer.

Renee Dua is a nephrologist and chief medical officer, Heal.

Image credit: Shutterstock.com


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