Make House Calls Research Articles

Factors associated with the frequency of house calls by primary care physicians

To evaluate factors associated with the frequency of house calls by primary care physicians. A cross-sectional design with a self-administered mailed survey. SITTING/PARTICIPANTS: 751 primary care physicians who care for Medicaid patients in Virginia. Among 389 physician respondents (52%), regular house callers (n = 216) were compared with occasional house callers (n = 162). Among physician characteristics, specialty and practice duration were associated with house call frequency. Regular house callers also more often cited chronic illness (67% vs. 20%, p less than 0.01) and terminal illness (67% vs. 40%, p less than 0.01) as indications for house calls, compared with occasional house callers. Use of visiting nurses to substitute for physician house calls was less often considered appropriate by frequent house callers (7% vs. 24%, p less than 0.01), and regular house callers were less likely to report being "too busy" to make house calls (71% vs. 29%, p less than 0.01). Multivariate analysis confirmed the association of these attitudes with house call frequency. These data suggest that specific attitudes among primary care physicians are associated with house call frequency.

House Calls Are Here to Stay

Sir.—In his essay on house calls, editorial board member Richard Blumberg reminisces about the good old days when doctors still made them.1After discussing their advantages and disadvantages, he concludes that house calls will probably remain archaic. Like much of the public, however, Dr Blumberg mistakenly believes that house calls are a thing of the past. Family physicians and general practitioners continue to spend a small, but important, part of their time visiting patients in their homes. In a survey conducted by the American Academy of Family Physicians, half of the family physicians spent between 0 and 6 hours a weeks making house calls.2A more recent national survey showed that almost two thirds (62%) of recent graduates of a family practice residency program made house calls: about half made them more often than once a month, and half less often. Eleven percent made between one and

THE HOUSE CALL—IS IT AN ANACHRONISM THAT HAS SEEN ITS DAY?

During World War II there was a shortage of physicians to serve the civilian population, including pediatricians and general practitioners. This resulted in the beginning of the trend to bring the child to the office, producing an end to house calls by the 1950s and early 1960s. Apparently, children did not suffer as a consequence, and during the continuing period of physician shortage the practice persisted, since one could see many more children in the office if house calls were not made. While the physician shortage resolved, the custom has continued. With the renewed interest in home care for the elderly, one is reminded ofthat era in which pediatricians made house calls. This is a phenomenon that is completely unknown to modern-day pediatricians, and, thus, it might be postulated that for the past 30 years they have not made house calls. Is this good, a custom that should

ACUTE REMUNERATIVE NEUROLOGY

journal ads are bright and colorful. They describe EEG and EMG equipment with trendy, catchy headings: A New Dimension in Neurodiagnostics The Leading Light in EMG/Evoked Responses Now Sleep Labs Can Make House Calls Evoked Potential Technology at Your Fingertips (Learn in the morning, operate in the afternoon) The New, Mighty Navigator equipment names are similarly virile-Madison Avenue at its best: one is called NEUROSTAR; others, MYSTRO, CONCERTO, and VIKING. One unit is billed as complete neurodiagnostic laboratory, promising neurometric analysis, brain map ping (see events inside your patient's brain), ambulatory EEG recording, evoked potentials, sleep laboratory tracings, and surgical monitoring. Practitioners are exhorted to Equip Your Practice for Under 40K! Some ads promise that the equipment will pay for itself in just a month. Another rejoices that the computerized diagnostic machine even fills out insurance reports ready for

ACUPUNCTURE ISN'T EVERYTHING

Mora, NM—Making house calls in this high valley surrounded by pinecovered mountains, Michael Green brings along his scalpel, tongue depressors, aspirin. . . and herbs. . . . Dr. Green is adapting to reality in this largely Hispanic area. And reality here is named Gabriela Pino, the town's curandera - folk healer. For decades, the 83-year-old Ms. Pino has been delivering babies. . . and dispensing folk remedies for colds, stomach aches, and teething pain. Her patients include the administrator of Dr. Green's clinic as well as his nurse, both of whom regularly refer clinic patients to her. . . . To many doctors, Ms. Pino will always be a witch. But increasingly, they are trying to bridge the wide gap between modern and folk medicine. In the Southwest, Hispanic culture and spiritual links to curanderismo remain powerful. In some psychosomatic-based illnesses, in fact, many modern doctors are conceding that folk healers may be able to do more for patients than they can. Citing a popular curanderismo technique for cleansing the soul, usually by rubbing an egg over the patient's body, Wallace Marsh, a Lubbock, Texas, physician, comments, "You'd be surprised what a simple barrida can do. It's as effective and less costly than a gram of Valium." Many doctors, of course, are still suspicious of the curanderos and their mysterious herbs and potions. And outrageous frauds by dome curanderos haven't helped advance medical detente. . . In the Southwest, the continuing flow of immigrants from Latin America helps keep curanderismo alive. Like Ms. Pino, curanderos are usually older men and women who perceive their "calling from God" as a divine gift. They eschew high-tech diagnostic gear and scalpels and rely on herbs and prayers. For a common cold, Ms. Pino prefers canela bark from a tree just outside her house. She mashes it into a teapot filled with water, then stirs the brew as it heats up on her potbellied stove. Ms. Pino has potions for almost anything that ails you, but she refers serious cases—such as pneumonia or leukemia—to Dr. Green...

Psychiatric House Calls

Are house calls the province only of primary-care physicians—family physicians, general practitioners, internists, and/or pediatricians? The answer to this question is No, according to , edited by John A. Talbott, MD, and Alan Z. A. Manevitz, MD. Of interest is the dust jacket, where House Calls is printed in large capitals, while above it Psychiatric appears in much smaller type. Is this mute evidence, common in psychiatry, of a simultaneous divorce from and reentry into the field of medicine? is an entertaining and lively compendium of anecdotal experiences of many physicians, most of whom are psychiatrists, with many of the authors making house calls early in their training or shortly after beginning practice. It is of more than passing interest to note that at the University of Maryland Medical School a program to teach house calls to fourth-year medical students is included in the curriculum

Career development among residents completing primary care and traditional residencies in medicine at the Boston City Hospital, 1974-1983.

A primary care (PC) pathway was initiated within the medical residency program at Boston City Hospital (BCH) in 1974. The authors studied the PC and traditional (TD) track graduates of the program to compare career development, goals, and practice patterns. The 185 graduates of the nine resident cohorts from 1974 through 1983 were surveyed; the overall response rate was 74%. Primary care careers have been chosen by 81% of PC graduates, compared with 38% of TD graduates (p less than 0.001); career satisfaction is equally high in the two groups. Among the PC graduates, 68% are practicing in high-need areas, compared with only 37% of TD graduates (p less than 0.001). PC graduates are more likely to make house calls, provide extended office hours, round in nursing homes or chronic care facilities, and co-practice with nurse practitioners or physician's assistants, and they are more active in women's health care, care of the terminally ill, and treating patients with sexual dysfunction (all p less than 0.05). PC graduates utilize various community agencies more frequently and supplement patient education with outside resources more intensively (p less than 0.001). The career choices and practice locations of PC graduates reflect the training goals of the PC curriculum and differ from the career choices and practices of the TD graduates from the same program.

The institutionalization of geriatrics.

The institutionalization of geriatrics.

Physician house call services for medically needy, inner-city residents.

To increase access to services, a non-profit, voluntary health agency was developed to provide on-site services to residents of hotels and night shelters in the Skid Road area of Portland, Oregon. From a hotel-based clinic site, volunteer physicians, nurses, and medical students make house calls. During the first 18 months, 1,184 evaluations were made, and 21 hotels and two shelters visited. Volunteers were well accepted by residents and served as members of case management teams. The additional benefits of such a program vis-a-vis extension of local government's mission and student education are discussed.

Brave Days: Reflections of Six Decades Past

Brave Days: Reflections of Six Decades Past

Willie, a Girl from a Town Called Dallas by Willie Newbury Lewis

Reviews 341 ing from the bucking of a horse.) Unfortunately, Mr. Martin conforms to the idea that the myth of the cowboy is somehow based along the Texas-Montana axis. It is not. It is in connection with that word myth that much of the book’s merit appears. Mr. Martin does not approach myth as a falsehood, a fabrication intended to mislead, a straw idea for the clever journalist to demolish. Some of his best insights develop from the right application of an understanding of the richness of myth to the substance of the thirteen chapters. The reader can turn to almost any chapter and be satisfied with the cultural history that develops from this understanding. Mr. Martin recognizes the difference between the truth of folklore and the flatness of fact and is comfortable with the notion that fact and truth are not necessarily the same. Chapters 6 and 7, “Horseback Boys” and “Taking Stock,” are superb. Chapter 10, “Darlin’ Outlaws,” is a virtuoso treatment of Country-Western performers and values. Chapter 13, “The Last Roundup,” is a superb reprise of earlier discussion. Indeed, when the minor flaws are corrected, this book is solid, given the author’s Texas-Montana bias. But it should be, considering that it weighs 6*4 pounds, contrasting in this respect with Taylor and Maar’s excellent The American Cowboy (The Library of Congress, 1983), which dresses out at 2 pounds 10 ounces. LOUIE W. ATTEBERY The College of Idaho Willie, a Girl from a Town Called Dallas. By Willie Newbury Lewis. (College Station: Texas A&M University Press, 1984. 137 pages, $12.95.) Interest in cattle ranching in the West has expanded from an early narrow focus on old-time cowboys and ranching practices to a concern for women who lived there. Luchetti and Olwell’s fine collection of photographs in Women of the West and Myers’ perceptive discussion in Westering Women and the Frontier Experience 1800-1915 are good examples of this kind of work. Willie Lewis, at age ninety-two an experienced observer of much of the early days of cultural growth in Texas, writes knowledgeably of her early years as a socialite in a then-small town named Dallas and her later experiences in Dallas and Clarendon as the wife of an early-day rancher named Will Lewis. Lewis operated the 430,000 acre Spur Ranch and others such as the Shoe Bar and the R. O. in the Texas Panhandle in the early days of ranching in the area. Mrs. Lewis makes it very clear that her husband was a rancher, not a cowboy, for he never picked up the lifestyle and attire of the cowboy. One of Lewis’ principal concerns throughout her married life was under­ standing and coping with the aims, ambitions, and habits of her husband — twenty years her senior — who believed, as did most men of his generation, “that a woman’s function in life was limited to a few specific fields, such as being a man’s sexual partner, the mother of his children, the manager of his 342 Western American Literature household, and last, but of much importance, the means by which he displayed his success to the outside world” (p. 3). Willie, or Bill, as she was known, came to understand this so late that by the time her husband died she had already withdrawn into her own shell and created a life for herself that rarely included him. It was not until very late in her life, long after her husband’s death, that she realized he, in essence, had remained a bachelor all his life. Those interested in early life in Dallas will find much here. Mrs. Lewis comments on the various parties, balls, and debutante activities in which she and later her daughters were involved. The kind of trauma that affected their home during World War I and World War II is recounted, as are the educa­ tion experiences of the daughters and the “loss” of her only son to the same magnet of ranching that had robbed her of the affection of her husband. Early medical practices, when the family physician not only made house calls but conducted surgery in...

The Tallis Case

I approach my responsibilities of teaching cardiology to medical students and house officers with some ambivalence. Of course, I have always enjoyed and usually learned something from my contacts with these young colleagues, but lately their emphasis seems to be entirely on technical procedures. Few of my charges express an interest in entering full-time solo practice; most are not enthusiastic about honing their skills in bedside physical diagnosis. None believes in house calls. I can remember making house calls on people who were too poor for a society doctor but too proud for the clinic. My mind can still conjure up the kind of call I'd get, almost always at night. Doctor, can you come? Quick! It's Zadhr, he's not feeling too What seems to be the trouble? How should I know? He just doesn't feel good. Please come. It was usually more a plea than a command. I'd

Solo Practice-Reply

In Reply.— I am grateful to Dr MacNeal for pointing to a paragraph in my commentary that obviously lent itself to misinterpretation. I should have enlarged on my qualifying phrase as it was a generation ago. In a professional career that encompassed 57 years, I never was a paid faculty member and always made house calls, although I devoted approximately half of my time to teaching and research in a medical school. I long for a time when the pendulum may swing back to more emphasis on the ideal relationship between patient and physician that Dr MacNeal outlines so eloquently and knows from experience. The point I was trying to make is that modern medicine has become so complicated and a physician's time so filled with new services that he must either supply himself or delegate his duties—that working solo in the old sense is hardly possible. The group I

Home care keeps children out of the hospital

In Great Britain, nurses with training in pediatrics make house calls. Home care for children is provided in several cities in England and Scotland t o shorten hospital stays, or better yet, avoid them completely. When a British nurse told me there are so few children in hospitals that it is difficult to teach pediatric nursing, I was immediately interested. But she had reservations about home care. In herjudgment, it is more “tea and talk.” Despite the growing interest in home care in this country, the concept is also controversial here. In the US, home care has been directed primarily toward long-term care of the elderly as an alternative to nursing home care. For healthier patients, physicians and patients alike have accepted that it is more efficient to get the patient to the

We make house calls.

We make house calls.

ACS Short Courses make house calls

ACS Short Courses make house calls

The psychiatric house call.

Although caregivers in many disciplines have provided home visits as part of their services, psychiatrists have rarely made house calls. The author discusses some of the practical and emotional issues that have traditionally caused both patient and psychiatrist sufficient discomfort to limit this model of therapeutic intervention. Special emphasis is made in support of the psychiatric house call for elderly persons.

Who Can Make House Calls?

Who Can Make House Calls?

An autobiographical sketch.

Photograph taken by Frank Agee, a colleague, on the occasion oí Dr. Hodges's eightieth birthday celebration in Gainesville, FIa. AN AUTOBIOGRAPHICAL SKETCH* PAULC. HODGESi I. The Family a. my father My parents, Dr. Fred Jenner Hodges and Josephine Chesley Hodges, lived in Anderson, Indiana, at the time my twin sister, Virginia, and I were born, January 6, 1893. An older brother, Robert, had died in infancy, and a younger, Fred Jenner, Jr., born December 19, 1895, lives in Ann Arbor, Michigan, where for many years he was professor and chairman of radiology. Virginia, married to Frank Moulton, engineer and architect, lives in Madison, Wisconsin. At age 18, father received the B.Sc. degree from Michigan Agricultural College, East Lansing, served there two years as graduate instructor in chemistry, and for the year 1886-1887 was a graduate student at the University of Michigan in Ann Arbor. One year later, March 27, 1888, he received the M.D. degree from Chicago Medical College, Northwestern University, Chicago. Together with such associates as James B. Herrick and Ludvig Hektoen he served at Cook County Hospital, Chicago, as intern and then as what today would be termed resident in which capacity he numbered among his teachers Christian Fenger and Nicholas Senn. On completion of hospital service, he married Josephine Chesley on March 30, 1890, and departed shortly for Anderson, Indiana, where newly tapped natural gas pockets were stimulating a boom in manufacturing. By 1897, the gas gave out, depression ensued, and Fred Hodges with wife, children, father, one-seater carriage, and Kentucky mare "Kate" moved by rail to Ashland, Wisconsin, to join mother's brother-in-law, William T. Rinehart, M.D., in a blossoming medical and surgical practice. Four years later, at age 36 and only 13 years into what promised to be a brilliant medical career, father died of septicemia resulting from a finger infection acquired in performing an autopsy, complicated perhaps by typhoid. At that time, throughout the world it was commonplace for communities to discharge their raw sewage into the same bodies of water * A different version of this sketch, abbreviated from the original by Dr. Clyde M. Williams, was published in Pharos, vol. 36, no. I (January 1973). t Address: P. O. Box 308, Palmetto, Florida 33561. Perspectives in Biology and Medicine · Autumn 1973 | 17 from which they obtained their water supply. In the case of Ashland this was Chequamegon Bay, an arm of Lake Superior, and the winter of 1900-1901 saw a severe typhoid epidemic. My sister and I were among its victims and barely survived. .Shortly after arriving in Ashland my father, with the assistance of Dr. Rinehart (Uncle Will), launched a bimonthly medical journal called the Western Clinical Recorder—the first number appearing January 1899, the last, August 1900. Before the editorial work for further issues had been completed, my father's fatal illness intervened and Uncle Will, despite his numerous attributes, was not the man to carry on publication alone. The Rinehart Hospital in Ashland had been built 10 years before our family's arrival from Indiana, and for the 3 years preceding his death father operated it jointly with Uncle Will and with him added a large new section. The operation was a family affair. Annie Rinehart (mother's eldest sister) was business manager; their youngest sister, Mary (called Molly), operated "the drug room"; and mother was in charge of student nurses, supervised the sterilization of instruments and the preparation and sterilization of dressings, and helped with anesthesia. Father kept office hours in an office "downtown"; made house calls; did surgery; occasionally drove "Kate" the 12 miles to Odanah, an Indian reservation; organized , conducted, and played the B flat cornet in a chamber music group; played tennis whenever he could find a partner; fished for trout and muskellunge; hunted grouse and deer; and edited his medical magazine. He belonged to and was active in the affairs of several fraternal orders, helped coach the high school football team, and was division surgeon for a railroad and an insurance company. I was only 8 years old at his death, held him in admiration and affection, and, as I grew up, was taught to and...

A study of house calls in the practices of general practitioners.

The literature pertaining to house calls has been reviewed. An attempt has been made to define some of the underlying factors that influence the decisionmaking process of a sample of general practitioners in making house calls. The percentage of house call contacts was significantly higher for persons receiving fragmented care, severely ill patients, the elderly, and for persons with emotionally charged diagnoses. In the majority of house calls, the home appeared to be the elected site for the patient contact, fitting meaningfully into the pattern of the physician's total practice. If the discipline of family medicine is going to be considered a specialty, it must strive to have more of its unique tools embody a scientific approach for action.