The House Call Is Gone But There Are Better Strategies Than the One Being Used By Academia
The Wall Street Journal on February 9 published this op-ed by Bob Greene about a retired Dr. Charles Kemper from Chippewa Falls, Wisconsin who made house calls for 40 years. Dr. Kemper describes the first reaction to his arrival at the home of an ill patient as that of relief. The cavalry had arrived with him. So had hope.
That scenario, alas, is long gone. Doctors simply do not make house calls any more and probably with good reason. The ill today need access to technology and personnel that cannot come out of a single black bag. Furthermore, there simply aren’t enough doctors or nurses to care for all those in need at their homes, although patient-centered care is trying to do just that in an effort to decrease hospital readmission rates. For the most part, the house call is unlikely to be staging a great comeback in the near future.
Nonetheless, it is still the doctor’s job to provide relief, ease suffering, and alleviate pain and discomfort to the greatest extent possible, even if that is not at a patient’s own bedside.
I think of this as I have been dealing with a referral from far away. The patient wants to be seen at Anderson. She needs to be. There are still patients who uniquely require the insight and expertise that only a major cancer center can provide. Even other comprehensive cancer centers from which this patient comes, whose likely expertise is more research than clinically based, need the help of the clinical expertise of a place like Anderson frequently. At one point in the distant past, up to 10% of the diagnoses that patients received outside of Anderson were changed once the patient was seen at Anderson. The technology in diagnosis and treatment is unequalled at Anderson and the niche expertise of the faculty is not going to be found at most other places with departments of general oncology when Anderson has departments that are disease- and discipline-specific.
This brings me back to the blog I wrote about Anderson being too big.
I believe that there are more than enough patients to satisfy the needs of the financial crowd at Anderson if the front door on Holcombe was limited to admitting those in unique positions to be helped by Anderson or by dint of their diagnosis and qualifications for a clinical trial, could uniquely help Anderson and cancer care in general. This would take the pressure off the clinics, allow doctors more than adequate time with each patient, and carve a niche for Anderson in the health care landscape.
If Anderson wants to continue to see patients with routine oncologic problems, perhaps they would be best seen at one of the peripheral sites in Houston or beyond. The wise deployment of resources at 1515, limiting admission there to those who would uniquely benefit while outsourcing routine care to Katy and beyond would make sense, increase efficiency, and be almost as good as a house call.
It would also provide a great deal of relief. For patients and for doctors.