House Calls

… quite literally, visits at home by doctors… turn out to be both better for health and cost-saving, according to research pointed to by Wendell Potter.

My primary care doc actually visited me once at home when I was a whole lot less mobile than I am now; the visit was for a small procedure before which he didn’t want my bones to be jarred in transit. Now he knows the clutter I live in! 🙂 As a matter of routine, he does not make house calls, but he is so diligent and genuinely compassionate I wouldn’t trade him for any other PCP. And he came here when it really counted.

And now the Department of Veterans Affairs has demonstrated in actual practice that house calls save money, in addition to their other obvious advantages. Do you think Congress would listen? What’s that you say? No, sorry… I refuse to stick it in my ear!

It seems we must first lose what we once knew to find it and know it again.

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  • MandT  On Monday August 8, 2011 at 8:32 pm

    Finally, finally I found a doctor, who is also a healer….. It shouldn’t be that unusual, but it is and I am so grateful.

    • Steve  On Monday August 8, 2011 at 9:51 pm

      MandT, my doc was nearly chewed up and spit out by a system that had him attempting to care for several times as many patients as he thought he could serve properly. He hired his retired father, also a doc, to shoulder some of the load, but his father soon died. He tried hiring another young physician as an assistant; unfortunately, that guy really sucked. Desperate, my doc sold his practice to a “concierge medicine” firm, which hired him back to deal with a fixed maximum number of patients, each of whom pays a fixed quarterly fee to the firm for “all the primary medical care you can eat.” For some patients like me, in the first year of addressing diabetes and some of its terrifying side-effects, the deal could not have been better: I was seeing him at least twice a week, receiving good advice and appropriate prescriptions for three or four conditions at a time, and paying for a year’s primary care an amount about half what my former insurance company charged me for a month of premium. Of course, if something really goes awry, something requiring hospitalization before I reach Medicare age, I’m fucked… but I’m doing my best to avoid that, and most of my medical needs are routine now. It’s a good deal for me, and it’s a step toward sanity for my doc, who was previously handling a patient load that no one should ever have to face. It’s easy to see how things got that way: he’s really good at what he does, and he’s a genuinely sympathetic soul. (A side benefit: his office is within my limited driving distance. Every little bit helps.)

  • Bryan  On Monday August 8, 2011 at 9:21 pm

    My Mother is not readily mobile for a number of health related reasons, including heat indexes above 115, but if she calls one of her doctors to ask a question, the response is always the same – go to the emergency room.

    That is not a cost effective way to deliver health care, it is, however, an effective way of transmitting infectious diseases.

    Doctors, like airlines, are over-booked, so you can’t get an appointment within a week, and none of them would even consider leaving a slot open for emergencies.

    Even without house calls, if you could see a doctor within 24 hours it would be a huge improvement over the present system, and a hell of a lot cheaper that continually sending people to the emergency room.

    • Steve  On Monday August 8, 2011 at 9:57 pm

      Bryan, that approach is not only not cost-effective; it is also not effective as medical care. There are things my doc is not qualified to treat, and he has to send me to the ER for those (it’s happened exactly once in about three years). But I have never once known him to avoid doing whatever it took to serve his patients at the level a 21st-century physician should deliver. I can get an appointment with my doc on two days’ notice, sooner if necessary, and there is usually a choice of times on that day. I wish your mother could have such a physician and such an arrangement with him/her!

      • Bryan  On Monday August 8, 2011 at 10:47 pm

        The truly annoying thing is that in some areas you pay and get that kind of access, but it just isn’t available here. Doctors don’t get to make those kinds of decisions in group practices, everything is decided by the ‘managing partners’, who structure things to maximize their profits, not the welfare of the patients.

        The system doesn’t work for health care.

        • Steve  On Tuesday August 9, 2011 at 8:32 am

          Bryan, it’s like real estate: location, location, location, but you still have to have money, money, money, money. Having lived in various places only 3-5 miles from the Texas Medical Center (think: Bethesda; that will give you an idea of the size and scope) for decades, I was treated there only a handful of times in those decades, and then only when I had insurance… first as an employment benefit, and later on my own coin. The institutions at TMC, hospitals and schools (medical, nursing, public health, health research, etc.) spread over a few acres of incredibly pricey land right in the city, are models of high-end modern medical care, but it doesn’t help if you can’t afford them. As for group practices in the surrounding professional buildings, as I always put it, they’re not in business for your health.

          The best solution for an individual is to be born French, preferably in France. /snark

  • MandT  On Monday August 8, 2011 at 10:57 pm

    It is also true that ER is not free if you have more than $2000.00 in assets. When I became ill two months before Medicare my four ER visits totaled nearly $7000.00…I applied for State assistance and was told ‘too bad’. It wiped out my life savings. The State worker said the good news was that with my life savings wiped out I could re-apply, but by then I would be disqualified because Medicare would kick in. It’s like living in a Dickens novel.

    • Steve  On Tuesday August 9, 2011 at 8:42 am

      MandT, that is truly awful. Yes, that happened to me, too, when I went to the “free” ER for one miserable visit near the beginning of my problem, and while I was told it would be about $300, it turned out to be $2000. I arranged to pay it out over time, but yes, Dickens does come to mind as I think back on it.

      My other recent hospital encounters involved the wound on the foot, and at someone’s recommendation I went to St. Luke’s Episcopal Hospital. I was an outpatient; the whole examination took place within a day at a clinic… and the bills from contract docs at the clinic just kept coming. About a year later, again by referral, I went to a doc at Memorial Hermann; the doc assured me the wound was healed (it was, in fact) and the hospital charged me another fucking fortune.

      The current foot problem was addressed by the company that made my boot. While they have docs on staff to diagnose, fit, repair, etc., they sell prosthetics, not services; as expensive as it was, the boot proved to be the best bargain and the most life-transforming treatment. I wish I’d gone there first.

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