A History of Medical House Calls
May 1, 2017
Although they are uncommon today, medical house calls were commonplace as recently as the early 1960s. However, within a couple of decades, the percentage of physician interactions occurring during home visits dropped to 1 percent although signs are pointing towards it making a comeback, maybe not to pre-1960s levels but to a point where it is much more common than one out of a 100.
They were likely the norm during those earlier times because the primary mode of transportation for people throughout most of history consisted of their own two feet or perhaps a horse-drawn vehicle. However, the latter was expensive to own and maintain, so few had that option available to them. For those who only had walking as their primary form of transportation and were in desperate need of a doctor, that was clearly not going to work. Conversely, a healthy physician would presumably be able to move from one place to another with ease and possibly even have access to transportation options that many patients did not. A lack of access to not-yet-invented telephones also meant that no emergency numbers existed, and emergency situations were generally attended to by a general practitioner in the patient’s own home.
Advances in transportation then helped doctors move from patient to patient in an even more timely manner. The invention of telephones also greatly reduced the amount of time that it took patients or their family and friends to contact doctors during times of need since this process had previously consisted of someone physically rushing to where the doctor was assumed to be and getting them to the patient as quickly as possible.
Also of note is that physicians who were regularly making these urgent care visits generally made multiple trips to ensure that the patient was making progress while recovering. In the 1920s, doctors averaged four house calls for every illness. Visits also tended to be considerably longer than is the case today when doctors are consulted in their offices instead. The emotional connection between doctor and patient was much stronger during those earlier times as a result, and this tended to help the patients recover more quickly from their illnesses.
However, all of this changed in the 1960s as doctors started sending patients to emergency rooms and using offices while more and more of them started specializing in a specific field of medicine as opposed to the general practitioners who were ready for just about anything presented to them while providing immediate care in home settings. Not having access to much of the medical equipment that has been invented in the last several decades in home settings played a role too. One more possible impact was how significant medical insurance started becoming at around this time. Forty-eight percent of healthcare expenses were paid by patients in 1960; that dropped to 11 percent in 2014. As a result, patients experienced a loss of control over their interactions with doctors, including where they took place.
With that said, these types of home visits are making a bit of a comeback, and that trend may continue moving in that direction in the coming years. Some physicians are leading this change because of the emotional benefits to people such as those who cannot travel easily, live alone or are elderly. The doctors themselves also enjoy experiencing more of an emotional connection with their patients than is usually possible when speaking to them for just a few minutes in the office with another patient impatiently waiting to be helped in the back of their mind while doing so. Also, those physicians who focus on home visits no longer need to pay all of the expenses that are necessary when running an office.
The Seattle area is home to companies such as Costco and Microsoft who provide their employees with immediate care in home settings when necessary. In fact, Microsoft’s Mobile Medicine program has been around since 2006. The company had realized that many of its employees had been heading to a local emergency room for medical problems that were not life threatening and wanted to change that since emergency room visits tend to cost about 20 times as much as a house call does, and two-fifths of emergency room visits could have been handled by one.
Also, a 2004 study revealed that the number of hospital stays for nearly 100 elderly patients went down 62 percent and saved more than $250,000 when they were treated at home instead.
Although these recent developments do indicate that this may be trending upwards, it’s still up in the air just how much of a change there may be as doctors tend to take a significant hit to their paychecks the more house calls that they do, and the fact that much of the modern equipment that is used on patients today is not mobile does mean that many times patients are going to need to get themselves to a care center one way or another in order to get specialized treatment. More doctors are also likely going to have to be trained in general medicine in order for home care to increase substantially. However, the tremendous savings for those paying for home treatment when the alternative is going to an emergency room will definitely help create a demand for this as more and more people decide to go that route.
Another option that may start to be used more and more are virtual visits as a variety of companies have started offering this type of urgent care in the past several years. Most of those who have utilized virtual home care were able to have their medical issues resolved during the call, not needing to see a doctor in person. This option is especially valuable to those who live in rural areas as well as those who are not very mobile, regardless of where they live, or who are considering an emergency room visit as the other option.