House Calls

I spent a lot of time in my car last week, driving in heavy traffic and bad weather as winter storms swept across New England. Twice in one afternoon, I found myself creeping along at 20 mph or less, caught behind a phalanx of snow plows spraying road salt—annoying, but, I reminded myself, not a bad place to be with a mix of slush and snow falling from the sky.

Nothing to do but go with the slow flow and listen to the radio, monitoring traffic reports and the news. One item caught my attention—a new smartphone app called Doctor on Demand.

Available in 15 states, this app enables you to video chat with a licensed physician for $40 a call and get a prescription filled at a nearby pharmacy. And it’s not the first such app to emerge in the expanding market for instant medical diagnoses, a whole new twist on the notion of doctors who make house calls.

Convenient, certainly. For those who are rarely sick, suffering from the occasional cough, back pain or skin rash—the most common ailments treated by internists and pediatricians, according the Centers for Disease Control—it could be a real timesaver for patients and physicians, alike.

Of course, you have to be willing to risk sharing your intimate medical history over the Internet superhighway. Given what we now know about the NSA’s data collection vortex, I wouldn’t trust any secure server with that kind of personal information.

Nope, much as I hate spending hours in waiting rooms, I’ll take a personal, longterm relationship with each of my many docs, any day, over a virtual MD in the palm of my hand.

When I was growing up, doctors made real house calls as a routine part of their practice. Ours was an old fashioned GP named Dr. Grunberger, a Hungarian who spoke English with a thick accent, enumerated every dire diagnosis aloud as he sorted the possibilities, and got into heated arguments with my Teutonic mother, who had once aspired to be a physician and knew just enough medical terminology to sound intimidating. (She once diagnosed a red patch on my lip as a “contact dermatitis.” “What’s that?” I asked, aggravated and worried. “It’s a rash,” she answered, smugly. Well, why didn’t you just say that? I grumbled under my breath.)

I always awaited Dr. Grunberger’s visits to my feverish bedside with trepidation. He carried a huge, worn, black leather doctor’s bag, from which emerged his stethoscope (always cold), wide wooden tongue depressors (I have a strong gag reflex), and dreaded hypodermic needles. He smelled of alcohol wipes and spoke in rapid-fire bursts, and I could never understand what he was explaining to my mom.

For her, whatever their conflicts, it must have been wonderful to have him come to our house, rather than bundle up a sick child, drive to his office and sit with me in the waiting room. His first-hand knowledge of our home life also enabled him to make some astute medical decisions. When I was about nine years old, suffering from a fever and lower abdominal pain, he determined during a house call that my mother could monitor my condition well enough to avoid an unnecessary appendectomy.

I was very disappointed. My dad had bought me a cream-colored Christian Dior nightgown and matching robe with brown lace trim and apricot velvet bows for my anticipated stay in the hospital, and Madeline was one of my favorite books. I got to keep the fancy bedclothes and my appendix—but sorely missed what I thought would be the wonderful drama and doting family attention of an operation and hospital stay.

Dr. Grunberger was correct, of course. His assessment was based on a long-term relationship plus years of experience, training and observation. He had felt my sore belly with his fingertips. He knew my mother well, and even though they argued about diagnoses and treatments, trusted her to take appropriate steps if my condition worsened.

I no longer have the benefit of a doctor who makes house calls, but I am blessed by the next best kind of medical care: I have known my internist for more than three decades, my local rheumatologist for nearly as long. My rheumatologist at Boston Medical Center has been treating my scleroderma for at least 15 years, maybe more. I’ve lost track. And I have longterm, personal relationships with a raft of other specialists.

I may have to wait far too long for medical appointments. But once these gifted physicians enter the exam room, they each take as much time as I need to share my latest symptoms, as well as what’s going on in my life. They know me well enough not to push me into treatments that I feel are too aggressive, as well as when to persuade me to try something new and beneficial. When I’m depressed about complications, they sympathize and encourage. And when I’ve cried, they’ve held my hand or given a needed hug.

You can’t get that kind of care from an app.

Photo Credit: Dorothea Lang, “The camp nurse introduces doctor to mother of sick baby. Merrill, Klamath County, Oregon. FSA (Farm Security Administration) camp unit,” 1939, Library of Congress.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Comments

  1. Jesse Evans says:

    Hi Evie, thanks for the trip down memory lane. My Cousin Gordon (for whom my Son is named), died of polio contracted at the national Boy Scout jamboree in the early 50’s. I remember vividly my Mother’s anxiety whenever one of us got a fever, ever mindful of this family loss. When our doctor, (the only one in town) made house calls, her relief was palpable. My Brother and Sister got mild cases of polio, and my Father’s legs were paralyzed by it the day after I was born. Back then, even though Doctors actually could do less about disease, somehow they meant more to us for the more human services that only they could provide.
    Cheers, Jesse

    • Thanks, Jesse, for your thoughtful story. There are still doctors who make house calls, but from what I could discover online, you either have to pay a premium to belong to a concierge practice or meet low income criteria for regions that are served by groups like the Visiting Physicians Association. With so much attention to the bottom line in medical services, I think most of us will never have the benefits of home visits that meant so much to our parents when we were kids. Still, I feel very lucky to have a team of doctors whose compassion and willingness to take time with me makes up for the lack of convenience.

  2. Pat Bizzell says:

    Virtual doc vs. face to face doc–hmmm. This reminds me of current discussion in higher education about what is optimistically called “distance learning.” Now as a graduate student in Jewish studies, I have experienced some distance learning (I was in South Korea at the time) and found it to be surprisingly congenial, but I think that was at least in part because I had studied with the professor before and was able to enhance his emails with mental images of his kindly, droll face.

    I have never tried to be a virtual professor, but I learned from this experience how much organization is required, and probably a lot more time, at least if the teacher is going to stay in email contact with each student individually, as mine did. But all of my teaching work has been done face to face, and I have to say I prefer it that way. Not every student who has a question is willing to raise a hand, but in person, I can see confusion crossing someone’s face. Then again, a student was weeping in my office just the other day. She could have confided in me over the internet, but then, how would I have handed her a tissue?

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