Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

Is The House Call Dead?

This week I did something very unusual: I did a house call. A couple of weeks ago, I had done a matricectomy in the office on a patient with ALS. The patient tolerated the procedure well, but while obtaining the history from the patient's wife, I realized just how difficult it was for them to get to my office. When I asked the patient's wife if she'd like me to come out to their home, she looked at me for a full 10 seconds, as if I'd just grown horns on top of my head.

It was actually getting a bit uncomfortable for a minute until she said, "Are you for real? Are you really offering to do a house call? I didn't think anyone did that anymore."

After I convinced her that I was not in fact a figment of her imagination and I was indeed offering to do a house call, she changed back to normal and was very appreciative. When I did actually show up at her home to take care of her husband, she again thanked me profusely.

The surprise of my patient's wife and her immense gratitude started me thinking about house calls. Is the house call truly dead?

Over my almost seven years in practice, I've done no more than a large handful of house calls for patients that I felt were special cases, perhaps 10 or so. This patient was a case in point. He had ALS and was essentially immobile, although with full mental capacity. He and his wife were both older, and it was simply easier for me to come to them, than for them to lug all their medical accoutrements just to come to my office to follow up on a toenail procedure. I once had a postop patient that I saw at home after business hours, trying to avoid the emergency room. It turned out to be nothing but a little patient nervousness.

Tonight's Premier Lecture is
Differentiating Infected From Non-infected Wounds: How & Why?
Warren Joseph, DPM, FIDSA

Now, I might be naïve about some things, but I realize that almost no one does house calls anymore. House calls used to be common practice in medicine until the mid-1900's, but in our modern day society, it is next to impossible to make this a viable part of practice. In the time it takes to do one house call, a clinician can take care of many office patients.

However, house calls do still exist in some places. For example, I found a website that advertises a group, Doctors Making Housecalls, in California who take care of predominantly older patients in their homes. Similarly, a group of physicians called Urgent Med Housecalls, performs urgent house calls in the San Francisco Bay area.

I'm not sure exactly how they make this business model work, but good for them. Perhaps the house call isn't dead at all. Maybe this is a future niche field within medicine – and within podiatry? – that has a viable place, since the demand is likely to be high (since very few of us are doing it anymore).

For me, I do the occasional house call not because it's a good business option or a practice builder, but rather because it just seems the right thing to do under certain circumstances. Sometimes being a doctor just isn't convenient. I can accept that, how about you? Happy holidays.