Why have Doctors stopped making house-visits?

K. JAVEED NAYEEM writes: Most of the books that recount the experiences of medical practitioners from a bygone era, which I re-read from time to time, invariably tell us about their very interesting house -visit experiences.

A.J. Cronin’s autobiographical masterpiece Adventures in Two Worlds and his novel The Citadel are two very notable examples while James Herriot’s four omnibus editions are in no way inferior or far behind, although they deal with a vet’s adventures with animals and their very interesting owners.

In yester years, almost every movie would have a scene where a doctor, clutching his signature black bag, would make a house visit to see a patient. Interestingly, on his way out the bag would invariably be carried, by the patient’s son or other relative who would see the doctor off!

The mortifying diagnosis that the doctor would announce almost in a whisper would be TB, which then had no cure. And when a cure for TB finally did come somewhere in the early 1960s the diagnosis promptly changed to cancer, to heighten the impact of the patient’s helplessness.

Another thing that intrigued and amused me then was why while a doctor was shown making a house call even to see a mildly sick patient, almost no movie ever showed a patient being taken to see a doctor in his consulting room as is the practice now.

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While making house calls was almost standard practice for most doctors in the past, these days house-visits by doctors are almost unheard of and now even in a serious emergency it is almost impossible to get a doctor to come home and see a patient.

Very often when death comes calling at home and the relatives are not able to say with certainty whether the person is dead or only deeply unconscious it helps if a doctor sees him or her to dispel any lingering doubts. But to get a doctor to make a house visit even to do this is not very easy and anxious relatives have no other option but to shift the person to a hospital only to be told there that he or she is beyond any help.

It is also not very easy for elderly persons who stay alone without their siblings or other relatives to seek and get medical help in an emergency. These days this situation has become commonplace, with children working far away from home being unable to attend to the medical needs of their elderly parents on a day to day basis.

And most elderly people have some medical problem or the other which needs periodic attention.

Even for those aged people who have their relatives with them it is not very easy to go over to a hospital if they happen to be very infirm or bedridden especially if they live in an apartment block where a stretcher trolley cannot be accommodated in the elevator.

Considering all these difficulties it will certainly be a very great boon to society if some doctors are available who would be willing to make house calls in an emergency.

Very often I have told many doctors who have not been doing very well in their practices that they can certainly improve their standing by agreeing to make house calls and I have found that those who followed this advice seriously quickly became very successful. But the sad part is that once they become well known and patients start coming to their clinics they invariably stop going to patients’ homes in times of need.

There is indeed a very great demand for house calls in our society and doctors would do well to include this service in their daily practice.

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Some years ago I met a very successful doctor in Bangalore who is doing very well financially without any postgraduate qualifications. Very surprisingly he has no clinic. He only makes house calls every day and is busy from morning till evening six days a week.

He has a very organised approach and he registers all his calls in a diary and at the beginning of each day he prioritizes them according to the seriousness of his patients and the traffic conditions so that he does not waste time in traffic jams.

Every patient’s number is called back and recorded for safety’s sake and it is also messaged to another mobile phone at home. His driver doubles as his secretary, maintaining his diary and holding on to it at all times. He never accompanies his master into the patient’s house and he never leaves the car during the calls to preclude any compromise to their safety.

This doctor has become so popular that he gets regular referrals from consultants who can keep a better watch on their patients’ progress through him. He has now narrowed down his area of operation to what he can manage best and he told me that there is certainly much scope for many more players if they can co-ordinate their operations.

I hope this trend picks up and helps in getting medical care to bedridden patients’ bedsides in the comfort and convenience of their homes, saving them the bother of going to hospitals for every tiny problem. Thankfully this kind of medical care seems all set to make a beginning in our own city too.

A very close friend of mine and a fellow-physician with very good qualifications and a good deal of experience too called me up recently to tell me that he has seriously thought of starting this kind of practice as an act of public service. I was overjoyed and wished him well as I knew that he would indeed be doing some much needed good to ailing humanity.

I hope he does not get disillusioned by any initial teething troubles that are bound to be there and more importantly I also hope that other members of our fraternity see the sense in what he is embarking on and encourage him. Three cheers to the man who has decided to step out of the box to put some good cheer into the lives of those who need it most!

(K. Javeed Nayeem is a practising physician who writes a weekly column for Star of Mysore, where this piece originally appeared)