The Best Place For A Doctor's Visit (Hint: It's Not Their Office)
Back when I was in medical school, I thought I wanted to be an emergency room doctor; I had no idea house calls even still existed. But in my third year, I lucked out and was put on clinical rotations with a house-call doctor named George Taler. That’s when everything changed.
After a month of driving around the city visiting patients with Dr. Taler, I was hooked. I knew I wanted a different kind of life without the pressures of residency, dealing with hospital administrations, and shuffling patients in and out the door.
Even an auto mechanic takes the time to diagnose what’s wrong with your car in order to fix it. Shouldn’t a doctor do the same?
And so after graduation, I went straight into doing house calls for a nonprofit clinic in the poorest sections of the Washington, D.C.; Maryland; and Northern Virginia area.
Unfortunately, once the clinic’s grant ran dry, my patients were left in the lurch. But I was determined to find a way to continue to serve them.
Then, I had an idea. I realized that providing concierge house calls to residents, hotels, businesses, and VIPs could free me from the constricting rules set by Medicare and Medicaid. That change allowed me to provide equitable, excellent care to everyone.
From there, my concierge medical practice was born. I can’t imagine doing anything else.
What It's Really Like to Be a House-Call Doctor
As a house-call physician, my days are busy. I get up early, have my coffee and a simple breakfast. Then, I’m on the computer, looking at the map to plan my drive. For me, a typical day could mean six hours, or it could mean 12. I try to keep my schedule flexible, so I’m often out until well into the evening, and I’m available on the weekends, too.
Before leaving the house, I make sure to test my medical equipment. This includes a blood pressure cuff, an oxygen monitor, an EKG, an otoscope (a medical device used to look into the ears), and some strep tests — among many other items on a long list of the basic “tools of the trade.” It all fits into my small, old-fashioned black bag.
Then, I head out the door. Often a neighbor who’s up early gives me a smile and waves as I get behind the wheel. I’m easy to spot because everywhere I go I wear my blue scrubs with “House Call Doctor” embroidered on the back.
Every day is different, but I'm usually doing anything from checking in on some of the older folks in underserved communities to responding to a concierge patient’s cough, fever, back pain, or urgent medical issue.
My patients are all over the city — from the poorest to the most affluent neighborhoods. As for my elderly, home-bound patients who live in Southeast D.C.’s wards 7 and 8 (the lowest socioeconomic areas in the district), I provide my service as a charity.
What my concierge patients do pay, once they’re all better, is based solely on the value of the care they receive, not some artificially high price negotiated by an insurance company. Costs are itemized and include travel time, after-hours, weekends/holidays, medications, procedures, bedside diagnostics, follow-up, and coordination of specialist care or transfer to the hospital if needed.
A Doctor's Time Should Belong to Patients
The fact is, the simplicity of a good old-fashioned house call directly to the patient provides care in ways that today’s tangled web of HMOs and insurance company approval forms doesn’t. Not to mention, traditional doctors’ office hours just don’t cut it for most working folks.
Back in 1930, house calls made up 40 percent of doctor-patient encounters. But by the time the 1950s rolled around, that was already down to 10 percent. And in the 1990s, house calls were only reaching about 1 percent.
To me, this is unacceptable. First of all, what about bedridden patients? They are already sick, and now they have to figure out how to get to an office or a clinic. By some estimates, there are about 4 million people who need home-based care. These are some of the patients I aim to serve.
Further, even for patients who are able to make it to a clinic, with so many health care processes and systems standing between patients and doctors, there's little quality time shared.
I find it crazy that most people spend more time in their doctors' waiting rooms than with the doctors themselves. To me, caring cannot be rushed. Even an auto mechanic takes the time to diagnose what’s wrong with your car in order to fix it. Shouldn’t a doctor do the same?
The great part about making house calls is that I can give my patients as much time as they need — whether it’s 30 minutes or four hours.
When I was in medical school the chief residents had a saying, “Did you kill the king?” It’s a terrible metaphor for a doctor, I know, but what he meant was, “Did you do everything you possibly could to make sure the job was 100 percent done, finished, kaput?” Without following patients closely and personally, how can you be sure no stone is left unturned? Well, you can’t.
I Like Knowing I'm Doing Meaningful Work
By the time I’ve made all of my rounds, it’s been a long day — but also a great one. I get back into my car, adjust the rear-view mirror, and head home.
Making house calls means taking charge of life, and that isn’t just good for my patients; it’s good for everyone. It means I can spend more time with my family, doing things that matter. It means having time to keep my body and mind fit, reading and taking time to ponder what’s most important.
I also enjoy knowing that I play a meaningful role in the community where I was born and raised. When I have time, I like to visit family members of my former patients who have died. Sometimes these families still email or text me just to say hello. It’s a rewarding feeling when they just want to chat and see how I am.
To me, this is what it means to be a part of my community. It’s a meaningful life — exactly what the doctor ordered.