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DOCTORS MAKING HOUSECALLS : A
NEW(ISH) MODEL OF MEDICINE FOR
PEOPLE WITH DISABILITIES
March 4th, 2015 ADVOCACY
by Ami Claxton
Ami Claxton, PhD, lives in Cary, NC with her teenage son and her husband Chad, a C4/5 quadriplegic of
27 years. An 11 year veteran of an spinal cord injured caregiver life, she has a passion for writing to share
her experiences so that others can und...
MORE ABOUT THIS AUTHORMORE ARTICLES BY THIS AUTHOR
Contributors: Shayne Ladak, MD | P. Shaun Barbour, Ph.D.
Remember the old days when you were sick? You called your family doctor and he (yes, they were
all men) would make a housecall. Of course you don’t remember this! This hasn't been the
prevailing model of medicine for over 50 years. However, perhaps it should be. We just might have
medicine all backwards and should be going back to that model.
The Patient Perspective:
Author Ami Claxton’s husband Chad has a high-level spinal cord injury – he can shrug his shoulders
and turn his head but that is all. To visit a healthcare facility, he must have someone able to get him
dressed and into his wheelchair, someone with enough time available to drive him to an
appointment, and in a wheelchair accessible van. Now in their case, he has his wife (although time
off of her full-time job can be tricky when frequent visits are required) and they own a converted
minivan. But for many, perhaps even most, these can be the trifecta of woe – getting up, having a
driver and having access to a vehicle.
Furthermore, there are a wide variety of conditions, not just spinal cord injuries, for which it is difficult
for a patient to get to an office. The patient may have dementia and be too disoriented to
successfully navigate to an office. A patient may have other mobility issues such as those with ALS
or MS. Additionally, many patients may have personal transportation issues, such as lack of a
reliable car, or may have a medical condition that itself actually contraindicates mobility to get to an
office.
The latter issue is especially common in spinal cord injury; these individuals often get pressure sores
(decubitus ulcers) on their “sit bones”. The treatment for these sores is to keep all pressure off of
the sore until it is healed. This treatment for sores especially includes not getting into his or her
wheelchair. This then makes going to a doctor’s office impossible – where treatment is often
thwarted by inaccessible facilities for transferring to a table to turn and view a sore anyway.
The Doctor’s Perspective:
As a doctor, seeing a patient in his or her home environment brings a fuller picture of the patient to
an exam. There is something in a home visit that cannot be replicated in a sterile 15 minute office
visit. First, the patient is wearing his or her own clothes, not a skimpy paper gown that they are
nervously holding around themselves. Second, patients are often not (as) nervous within the four
walls of their own home. The term “white coat hypertension” exists for a reason! Patients in an office
can also be reluctant to ask questions.
In their own home, patients are more comfortable, and with that feeling of comfort comes increased
odds that they will be more willing to share their full medical history, articulate what their questions
are, and will be more willing to ask questions when they do not understand the diagnosis or
treatment you provide.
In addition, the physician gets a more complete picture of the home environment, family support, and
even what’s in the patient’s refrigerator. This so-called “refrigerator biopsy” may inform the physician
as to their eating habits and the consequent impact on health.
The Bottom Line:
In the area in which we live (Raleigh-Durham, NC), there is a practice, “Doctors Making Housecalls”
(DMH), which does exactly what it says – authors of this article Doctors Ladak and Barbour are
employees of this practice. Patients call for an appointment and a doctor will come to the patient,
and in this case, author Ami Claxton’s husband Chad. While DMH bills insurance as a normal
appointment, you must also pay a travel fee of approximately $95 per visit for the doctor to come see
you. This may put the service out of the reach of many for financial reasons.
However, medical housecalls have the potential to greatly increase quality of care and ultimately
reduce healthcare costs and hospital admissions through improved disease management. DMH is
one of sixteen practices throughout the country selected to participate in the Independence at Home
demonstration. The purpose of this inquiry is to demonstrate that the physician home visit practice
model, officially known as Home-Based Primary Care, can reduce the total cost of care even while
improving quality of care and patient satisfaction. Through this research we hope to show that
patient home visits greatly reduce costs, increase patient satisfaction, and most importantly will
improve patient outcomes.