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House Calls Make a Comeback: Page 2 of 2

House Calls Make a Comeback: Page 2 of 2

Miller says it's a shame that house calls aren't more highly valued. One of his peers said he wasn't interested in home-based medicine because "it doesn't improve your resume." But, Miller adds, "then you talk to the patients and you find it is valued. There is a whole world out here that most physicians don't know about, and this is a way to get them access to the system." He adds that, for variety, making house calls can't be beat. "I see a population that most physicians just don't see -- from MS and quadriplegic patients, to the morbidly obese and some severely demented patients."

It's not all roses

While spending more time with patients and seeing fewer of them may sound appealing, making house calls all day isn't necessarily a dream job. "I think it takes three things to be a good house call physician," Ajiri says. "First, you have to be a physician who, clinically, can take very good care of patients. Mostly, these are older patients with multiple problems, and being an internist or geriatrician is probably beneficial."

Second, he says, it helps to have a down-to-earth attitude. "You are a guest in their home, no matter how humble it is," Ajiri says. Lastly, house call doctors must practice great documentation. "You have to be legible and thorough, because even if you are clinically great and the patients love you, if you don't get the right thing down in your notes, you'll get in trouble."

Row says that while audits can occur in extreme cases, for most physicians, the danger of having sloppy or incomplete documentation lies in payment denials. Many Medicare intermediaries are unfamiliar with house calls as an element of modern medicine. "They may not know what they are looking at and reject claims. I've talked with many physicians who have had to explain it all to some medical director in order to get paid. Because this is new, it is going to be questioned more often."

Boal says that some physicians have trouble with the "uncertainty" of this kind of medicine. "You don't always have technology with you," he explains. In his own black bag, Boal carries an otoscope, blood draw equipment, an ophthalmoscope, debridement gear, equipment for joint injections, a blood pressure cuff, a stethoscope, and some common medications like steroids and vaccines.

One thing is certain, though. Boal, like any physician who makes home visits, can tell the story of some frail elderly patient who has had an effect him. Of all his house calls, Boal's first sticks most clearly in his mind: an older, slightly demented woman in East Harlem, essentially trapped in her second floor apartment. "She would sometimes stand up and wouldn't be able to sit down," recalls Boal. "This was 10 blocks from the hospital, but she might as well have been on an island. I just wasn't prepared for what I saw. This -- and every subsequent visit -- has sensitized me to the way people live. When they come into the office having missed appointments or without their meds, you assume it's because they aren't interested. But people have very complicated lives, and you don't really realize that until you see them in their own environment."

Lisa Jaffe Hubbell can be reached via editor@physicianspractice.com 

This article originally appeared in the September/October 2002 issue of Physicians Practice.

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