Remember Marcus Welby, the doctor who would take calls and make visits 24 hours a day? While I may have been too young to have in-depth recall of Marcus Welby, M.D., my lasting impression as a kid was two-fold:
1. Dr. Welby had a moral and professional compass that oriented his life and professional ethos around the “right thing to do.”
2. His effort to visit a patient’s bedside was far more humane than telling his patients to just go to the E.R. (and wait with other sick people, see an unfamiliar doctor, and then pick up medications from a pharmacy before finally going home.)
So what happened to the house call?
It’s simple: how many patients can a doctor see in one day in the office versus making house calls? Clearly, it’s more efficient and economical for doctors to have patients come to them at a fixed location rather than doctors going to patients. For this reason, and because of the limited payments to doctors from insurance companies, most doctors and clinicians can only afford to see patients in an office or hospital setting.
So although it’s more efficient for patients to come to the doctor, the problem is that is very difficult for some who is sick in bed and needs medical attention.
To illustrate this, let’s follow two fictional patients, Betty Brown and Betty Black, with identical conditions and in need of the identical medical attention. Both are 45 years old with existing high blood pressure and migraines.
• Day 1: both have nausea, vomiting and diarrhea with fevers, chills and sweats. They cannot keep down fluids, have no energy and full-body aches, and are hopeful this is a 24-hour flu.
• Day 2: both are bedridden with fevers, unable to complete basic daily living activities, and send their husbands to the drugstore for an over-the-counter cold/flu medication. They are concerned their conditions are serious, and they may need a prescription from their doctor.
Day 3: Betty Brown calls her primary care doctor and is told he has an opening in two weeks. Her only alternative is going to the Emergency Room. She is so weak she needs her husband’s assistance to help her out of bed. They go to the E.R., where they check in among a room full of other ill people. She is initially seen by a triage nurse, who determines the severity level of her illness and where in line she will be in the context of all the others.
Just then an ambulance arrives with an acute heart attack patient. After some time in the waiting room, Betty is finally taken to have blood drawn, sees a doctor who determines she is dehydrated, and then starts an IV and some IV anti-nausea medications. She feels better in three hours, but her blood test shows she’s not sick enough to be admitted, so she is given paper discharge instructions with a prescription to fill at the pharmacy.
Summary: Almost six hours ER round trip/wait time/pharmacy trips, but only seven minutes with the doctor, and almost no follow-up time between Betty’s E.R. and primary care doctor visit because E.R. doctors work on shifts, and there is no one for her to follow up with. She slowly convalesces to health over the next five days.
Cost: $150 co-pay and $500 co-insurance, which will be billed in three months
Infection risk: high
Error probability: moderate
Feel-good quotient: low
Day 3: Betty Black calls her house call doctor, who says he will arrive within two hours. Her doctor visits, determines she is dehydrated, starts an IV, and gives her IV anti-nausea medication. He then updates her medical record on his laptop computer.
Her doctor leaves Betty with enough medication for 24 hours and electronically submits her prescription to the pharmacy so it’s waiting for her when she gets there. The next day, he sends her a follow-up e-mail to which she responds, and Betty eventually gets better over the next few days.
Summary: Two hours waiting in her own bed for her own doctor to arrive, 45 minutes with her doctor, all the follow-up she needs by e-mail and phone.
Cost: $500 billed to a credit card and submitted to insurance with $250 reimbursement
Infection risk: low
Error probability: low
Feel-good quotient: high
Fortunately, this scenario has inspired many doctors to provide value to their patients through high-“touch” services like house calls, which are making a comeback. Long live Marcus Welby!
Dr. Clifford Sewell is a founding member of Current Health Medical Group, providing comprehensive primary care, advocacy, and tech-enabled patient-centered care. Send your comments and questions to Current Health at firstname.lastname@example.org.
Why house calls are making a comeback
Why house calls are making a comeback