A Shift in Healthcare: Doctors Switching from Home Visits to Clinic Practice

The tradition of doctors making house calls to provide medical care has largely faded in recent decades, with significant changes due to various socio-economic and technological factors. This shift, marked by my personal experience in the 1970s, reflects broader trends in the healthcare industry and patient care.

The Decline of House Calls

My son was sick in 1967, and the pediatrician came to my apartment. By around 1971, however, this was no longer the norm. I was informed that doctors no longer performed home visits, as it was no longer considered an efficient method to deliver medical care. Doctors explained that a typical office visit could last 10-15 minutes, allowing them to see up to four patients per hour. In contrast, home visits were far more time-consuming, with transportation times making it nearly impossible to see as many as two patients during a regular workday. Doctors emphasized that 'time is money,' so they preferred the efficiency of a centralized office environment.

Historical Context and Evolution

The decline of home visits began with the widespread availability of personal transportation, such as cars. Additionally, the advent of health insurance made it increasingly difficult for doctors to be paid for house calls. However, the true transformation occurred as hospitals and medical practices realized that they could see a significantly greater number of patients in a given time period by maintaining a centralized location.

Despite these changes, some medical practices today still offer mobile services, bringing healthcare to patients' homes. In southern California, for example, there are practices that primarily focus on house calls, catering to specific medical needs and situations. Earlier generations of doctors, such as my father, a veterinarian in his 50s, continued to provide home visits, but this is less common in veterinary practices now.

The Rise of Modern Healthcare

Modern healthcare has evolved significantly since the days of buggy rides and in-person patient interviews. Today, nurses assist in gathering vital information and patient histories, allowing doctors to focus solely on presenting complaints. Technology, such as computerized systems, has revolutionized the way medical orders are processed, but these systems do not always facilitate efficient home visits. In earlier times, doctors could simply write on script pads, using pen and paper to document patient information.

Adapting to Special Circumstances

Despite the overall trend away from home visits, there are still exceptional circumstances where doctors make house calls. For instance, at my current clinic, we have a population of Amish patients who are not only resistant to visiting a clinic but may also face transportation challenges. As a result, medical practitioners, including a pediatric neurologist, conduct house calls to ensure that these patients receive the care they need.

Moreover, the concept of house calls has persisted in other parts of the world. For example, in India, it is more common for veterinarians to make home visits, reflecting local cultural and logistical needs.

Conclusion

The transition from home visits to clinic-based care represents a significant shift in the healthcare industry. While this change has been largely driven by economic and technological factors, its impact on patient care is undeniable. In the face of unique needs, however, the practice of making house calls remains a vital and valuable service in certain communities.