Most people today have never had a house call from their doctor. I confess that I’ve never had one myself. But I have made a few house calls in my time. There’s no doubt, however, that this practice is a dying art.
Bob Greene, writing in The Wall Street Journal, interviewed Dr. Charles Kemper of northern Wisconsin who practiced for forty years in the town of Chippew Falls, population 14,000. Dr. Kemper, now retired, is 98 years old and recalls a different era in medicine.
“The relief in their eyes,” said Dr. Kemper. “That’s what I saw when they opened the front door. There was often deep worry in their eyes, too, but the main thing I saw was relief; relief that I had come to their home, that I had arrived. That’s a look that a man never forgets.”
Dr. Kemper practiced from the 1940s to the 1980s. I began my career in 1975 when I entered medical school. Even then we were being discouraged from making too many house calls because of the limitations of such visits compared to the vast array of technology and resources available in modern hospitals. But something was being lost in the doctor-patient relationship.
Dr. Kemper still exhibits the “old school” attitudes of so many of the doctors I trained with and practiced among in the last forty years. “It was never a nuisance,” Dr. Kemper said. “If someone was calling at 3 a.m., I didn’t have to ask them if it was an emergency. They wouldn’t be calling me if it wasn’t. I was out of bed and out of the house within 10 minutes. I didn’t waste time asking if they thought it could wait until morning, Of course it couldn’t. They needed me there, and they needed me now.”
Unfortunately, there are fewer doctors today with his attitude. Even in my career I’ve seen a declining interest among younger physicians to see patients in the hospital emergency room, let alone make house calls. Doctor-patient relationships are taken for granted.
When I started my practice in the 1980s, it was routine for me to see every patient who needed an orthopedic consultation in the hospital ER. It was the rare case indeed when the ER physician handled the problem and simply referred the patient to my office. Today, it is just the opposite. It is rare when the orthopedic doctor-on-call actually goes to see the patient.
I know this because many people wind up in my office seeking treatment when they didn’t get it in the ER by the orthopedist-on-call. Even worse, many who show up in that doctor’s office a few days later are turned away because the doctor doesn’t accept their insurance. This is called “abandonment” by the legal profession and by the ethical standards of medicine of my generation.
This problem is not limited to orthopedics. Most primary care physicians today don’t even go to the hospital. They rely on “hospitalists”, physicians employed by the hospitals, to care for their patients when they are hospitalized. My “old school” primary care physician just retired and I’m having difficulty finding a new one who is willing to make hospital rounds.
Sadly, this trend is continuing from the era of Dr. Kemper, to my era, to the present generation of physicians. Doctors are forgetting that they have a sacred oath to care for the sick and injured whenever it is necessary; not just when it is convenient. The culture of medicine is changing, and not for the better.
This is why I oppose any system of healthcare that removes all incentives from doctors to provide the best quality care for all patients. Fee-for-service and an open market where patients can choose their doctors incentivizes doctors to do their best for everyone. They establish relationships and by doing so they build a reputation in the community that will last throughout their career.
On the other hand, single-payer systems, like Canada and the VA, remove all incentives for such quality care since patients have no choices in selecting their doctors. Doctors need not concern themselves with building a quality reputation when their income is standardized and the flow of patients is guaranteed. The result is sub-standard care, inefficiency and delays in treatment.
America has always enjoyed the best quality healthcare in the world. But changes in our culture and our healthcare system now threaten the future of that care. Only a return to a system that gives patients maximum flexibility in choosing their doctors and doctors maximum incentives to provide the best care possible can alter that future.