Home Visits - are they things of the past?

One day in the middle of my third year of medical school, I was walking home from clinic when I met the Assistant Dean for Academic Affairs of my school, a general internist, walking down my street. We struck up a conversation and, when I asked her what she was doing on my street, she mentioned that she was doing a home visit for one of her patients.

"Home visit?" I responded in surprise. "You mean doctors still do those?"

"Yes, for a few of my patients who are home-bound."

Even though less than 100 years ago most doctors only did home visits, I had thought that today the home visit was a phenomenon restricted to only rural areas. The reasons?

• Doctors just don't have the time nowadays.
• Doctors can't afford to do it financially!

Little had I thought that I'd see my Assistant Dean, an incredibly busy administrator and clinician, doing home visits.

Right now, a year later, I'm doing a geriatrics rotation. During my geriatrics rotation, I spend a couple of days in clinic, a couple of days at nursing homes and rehab centers and the majority of my days doing home visits. Our school's geriatrics department is structured such that all patients who are home-bound are seen in their home environment.

Last Tuesday, my first day doing home visits, I started the day questioning the value of home visits. It was over 90 F outside and humid and, as we trekked up a hill to my preceptor's first patient, she warned me that most of her patients didn't believe in or couldn't afford air conditioning. But as soon as our first visit began, my position started to change even though sweat was pouring down my face and arms. I learned that Ms. H was falling all the time because she had numerous rugs in her apartment. I talked with Mr. E's building manager about the numerous times Mr. E had flooded his apartment and how he was at risk for eviction. Despite Ms. M's assertions that she took her meds regularly, I learned that she didn't because months worth of meds were sitting on her kitchen counter.

And not only were we clinicians learning more about our patients, the patients were also much more comfortable in their home environment. Especially for elderly patients many of whom are hearing or sight impaired, navigating a hospital or clinic's reflective floors, fluorescent lights and white walls can be frightening.

So, can we, as future family doctors, incorporate home visits into our future practices? One half day a week for our patients who need it? I would challenge each of us to leave the comfort zone of our offices and clinics and enter into the homes and communities of our patients. It is there that we can best serve them!