I Approve My Tax Dollars to do That: Re-Vamp Health Care

The Obama Administration has pointed to and praised the Affordable Health Care Act as the way to fix our nation's broken health care system. But what if the solution actually involves the opposite? What if the disintegration of structured hierarchical medicine and insurance will increase the availabilty and quality of health care? 

I'm referring to the re-establishment of the house call practice.

Most Americans have never interacted with a family doctor who comes to their home and oversees their primary health care. Here there are no cold exam tables, no waiting rooms, and no stark white lab coats. I would not be familiar with such a concept either had I not grown up tagging along with my mom on appointments as she juggled her black doctor's bag in one hand and a rambunctious 2-week-old me in the other. 

With the back of her Toyota 4-runner loaded up with vaccines, records and other supplies, she drives from appointment to appointment rather than insisting her clients come to her. She has approximately 200 patients. Her paperwork office is in our house. She adjusts her prices based on a client's income so that the patient still receives adequate care. She knows every client by name and face. My mom leaves her cell phone number on the answering machine so that if one of her patients has an emergency, the client can easily get ahold of her. When we go on vacation, she always leaves that number as well. Though it is frustrating to get interrupted on holidays or vacations, she argues she took an oath; and she intends to uphold it. 

Some of her freedom stems from the fact she's a veterinarian as opposed to a doctor. But during my last visit home, an elderly client called, saying she had fallen and her hip hurt. My mom takes care of her cats. Despite having had knee replacement surgery a five weeks earlier, she and I drove over to this client's house to evaluate and comfort her. We ended up calling 911 and waiting with her until the ambulance arrived. Once home again, she attempted to contact the woman's family in Arizona. She even made arrangement for the care of the woman's cats. Talking to her about it later, I asked why she went over instead of just calling 911 from our house. She said, "You really get to know someone when you see them in the context of their real life. You can't do that in an office." 

An example of how house call vets interact with both their clients and their patients. Note the oven in the background. Both dog and vet are sitting on the floor. Neither look stressed or upset. 

Photo credit: http://www.yourathomevet.com/html/aboutus.html 

My mom understands where her clients are coming from and how they feel toward their animals. She can relate to them as a parent. She knows them on such a more personal level because of how she conducts her practice. Since her patients are less stressed without the hassle of transport to a clinic, her practice benefits the animals too. While there is a travel fee, her services are affordable. Whenever a problem arises that she cannot accommodate, she refers her clients to local hospitals. In a 2001 interview with the Boston Globe, she said, "I'm a primary-care doctor. I do the things I can do well; when it's something that's better taken care of at a hospital, I refer people." (ttp://pqasb.pqarchiver.com/boston-sub/access/70460160.html?FMT=FT&FMTS=ABS:FT&type=current&date=Apr+1%2C+2001&author=Naomi+R.+Kooker%2C+)

One client told me, "It's so comforting to know that when I have a problem, I don't have to wait for a call back or speak with a grouchy receptionist. I can speak directly with my dog's veterinarian. If he has a problem that requires more than she can do, she tells me and I take him into a clinic. But then when I know it's time, she'll be there to put him down in my own home. What pet owner doesn't want that?" 

Many of our problems in human medicine would benefit from implementing house call or house-call like practices. The key characteristic is being able to engage with your patients on a personal enough level that you can help them develop the best health care plan. Patients have to trust you, and feel like you understand them. Without that trust, the doctor-patient relationship is doomed and ultimately the patient suffers. 

In my next blog post, I will discuss a experimental system taking hold in the United States is trying to improve care in rural areas by integrating a house call approach with more advanced care. Who ever thought Mississippi would have something to learn from Iran?