Schwab: What was lost when doctors stopped making house calls

More than just a convenience, a house call could inform a doctor about the patient’s care at home.

By Sid Schwab / Herald Columnist

Let’s take a break from worrying that, aided by the most corrupt and hyper-partisan Supreme Court in history and a non-stop disinformation campaign from all parts of the rightwingosphere, The World’s Greatest Democracy™ might elect a convicted felon and lifelong liar who pledges to end it and to purge experts and opponents, Stalin-like. Hunter Biden’s rigged trial must wait for another time, too.

So here’s an essay I wrote for a now-defunct writers’ website. The first offering I submitted (not this one) got 30,000 views, so they kept asking for more. Which explains why they failed.

When I applied to medical school I imagined myself one day making house calls; good ol’ Doc Schwab, paid in chickens and pies, smiles, tears, and blackberry jam. There I’d be, delivering babies in bedrooms, patchin’ up Farmer Jones’s leg on the sofa, shaking out thermometers and feeling foreheads.

I became a surgeon.

Early in my practice, when I had time on my hands, and to some degree throughout my career, I made house calls, the old-time doc I’d imagined. As I got busier I had to triage my time; people with a simple problem for whom a trip to my office was especially difficult, living not too far away. But as a youngster there were occasions when I went quite out of the way, and spent a lot of time.

For example: “The Phone Call.” A woman awaits the news of a breast biopsy I’d done; I call her and note the stoppage of breath at the other end of the conversation. To say she should come in for the results is to let her know but provide no support. To give the news over the phone feels cold and impersonal. So I’d split the difference by breaking the news as gently as I could and inviting her in for an immediate consultation. Sometimes, early on, I reversed the equation and said, “How about if I come over and we can talk about it?”

One time, in my pre-gray, abundant-hair days, after I’d spent at least an hour at their home, my patient and her husband gushed their appreciation for the visit and my care to that point, but announced they’d be going to Seattle for treatment. Probably thought I looked too young. Gray hair: a welcome advantage for ripening doctors.

Most of the time, my house calls were to a post-op patient, usually older, having a hard time getting around: Check a wound, a little debridement, change a bandage, remove or unclog a drain. I’d load up with a few tools, some tape and gauze and ointments stuffed into my classic doctor bag, a name-embossed med-school graduation gift from my grandmother. Walking to the door, I’d imagine what the neighbors thought, figuring they’d be jealous: Miss Jones has a heck of a doctor there.

Always the visit was appreciated; frequently met with amazement. Sometimes it was my own, finding out how my patients lived, in a trailer, in an unkempt crumbling home, in a fancy joint with all the options. And I’d learn how they were able, or not, to carry out the post-op instructions I’d given them. Which led to a much more practical and pragmatic approach to what I’d tell people about after-care at home.

Once, I got a call from a feisty old lady for whom I’d recently done a mastectomy; she was worried about her wound, or a drain, or something. To her obvious delight I’d said, “Well, I’m almost done here, how ‘bout I swing by your place and have a look?” She answered the door buck naked from the waist up, her unoperated side of the voluminous variety; responding to my surprise she said, “Hell, I figured you’d want to see it anyway, so why get dressed?” Her home was right on a main street. No screeching tires, far as I recall.

Making house calls always made me feel good, and the benefits were invariably mutual. In my medical school, each first-year student was matched with a family in which the wife was pregnant. We followed her through pregnancy and delivery, which I did with supervision, and were involved in the care of the baby. At least one home visit was a requirement, and we’d meet in groups afterward to discuss how it went. The real import was in learning how patients’ conditions are part of an entire life and not just the little slice of it in which we see them.

All doctors — especially surgeons, who typically send people home significantly altered, if only temporarily, hopefully — would learn from seeing patients in their homes. It is, of course, completely impractical and nearly impossible nowadays, time and compensation (and liability) being among the reasons why it rarely happens.

Not to mention the possibility of seeing an old lady nearly naked at her front door.

Email Sid Schwab at columnsid@gmail.com.

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