when i first started out in private practice i had extra time on my hands, so i would occasionally make a house call, usually to a home bound senior. i always enjoyed it. there is just something about entering another person's home, being a guest, that personalizes and humanizes the encounter in a way that no time in the exam room can match. it isn't always necessary to have that, but it is something i perceive as having real value in the right setting. interestingly, i can easily remember the details of each house call i've made. ask me to remember an office visit from two days ago and i guarantee the recollection is far less clear.
currently there is just no time in my day to drive to someone's home for an appointment. (i once read an article that suggested that to maximize their efficiency doctors should have a charting station right outside their exam rooms, and that they should never stray from that triangle -- who comes up with this stuff?) so the house call feels like a luxury beyond my reach. but i do fantasize about how nice it would be to travel from home to home to visit my patients. i imagine that i would spend my mornings in the office, seeing my more able-bodied patients, making phone calls, and handling all the minutia of my practice (i.e. filling out forms), and then i would grab my bag, head to the car, and spend a reasonably paced afternoon making house calls.
i know there are some doctors out there that still incorporate house calls into their practices, or even build their practices around house calls, but i just don't know how they manage it financially. i suppose they have lower overhead if they don't have an office. for now, i appease my fantasy by making an occasional visit to someone to whom i know it will mean a lot, usually more of a social visit, one that says i'm thinking about you, i care about you. in fact, i will be making one today, and i am looking forward to it.
here's a link to doctor fantasy #1: http://happyinternist.blogspot.com/2011/03/doctor-fantasy-1.html