April 20, 2001 -- Remember when your child's doctor used to make house calls? You don't? Well, here's a second chance, because pediatric house calls may be making a comeback.
While there is no official study planned or in the works, word of mouth suggests that more and more pediatricians may be making house calls. A recent survey by the American Academy of Pediatrics (AAP) found that half of those polled offered house calls to all patients and another 54% made house calls only to the very sick. Still, it's obviously not in some doctor's plans, because about a third of the 729 pediatricians polled ignored the question about house calls altogether.
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When asked whether or not she makes house calls, Paula Elbirt, MD, a pediatrician in New York, replies "sometimes."
Elbirt made her first house call when a parent called saying that her newborn had a 104 degree fever and that her husband was out of town and her other three children were awake. Clearly this mother wasn't going to make it into the office, says Elbirt, who's also the author of "Dr. Paula's House Calls to Newborns".
Now, Elbirt's house calls are mostly after hours. "After hours, house calls can be your very best friend. They have saved me from opening the office or going to the emergency room many a time," she tells WebMD.
"But even a nonemergency can still be something that a mom can't deal with for another 12 hours like a screaming ear infection," she says.
In addition, "house calls instill devotion and gratitude in the family," Elbirt says. These days, "anything you can do to improve the relationship and lower the hostility between consumers and healthcare providers is worth doing if you are going to survive financially and emotionally as a physician," she says.
Many practices may also advertise that they do house calls as a way to increase traffic, and thus revenues, to their practice, Elbirt says.
But house calls are not without their risks.
"The danger of doing house calls is twofold, " she tells WebMD. "The main one is that you may be in a situation that you didn't anticipate with less equipment than you need. The field doctor's bag can not carry a lot of tricks," she says, noting that fortunately this is a rare occurrence because emergencies can be weeded out during an initial phone call.
"The less serious danger is that if parents get a sense that they can get a doctor to come to the house, they may delay seeking care thinking if it gets worse, the doctor will come running," Elbirt says.
It's difficult to do house calls during normal working hours unless your practice has a person who is designated to make them on a given day, she says. Also, since insurance may not reimburse for house calls, a price needs to be agreed upon in advance.
And since it is 2001 after all, not the 1950s, of course some of today's house calls have a high-tech twist.
One pediatrician, Alan Greene, MD, an attending pediatrician at Stanford Children's Hospital and an assistant clinical professor of pediatrics at Stanford University Medical School put up a web site in 1995 to augment visits with patients and their parents.
"When I started in general office pediatrics, there just wasn't enough time to give the amount and depth of information to make a difference," he tells WebMD. "I could treat an ear infection but there wasn't enough time to investigate the possible causes so I put up a web site to supply the extra background information on common and rare conditions affecting children for parents to access at their convenience."
But virtual house calls really come into play with his five-day-a-week live chats where parents can ask specific questions via the web on a first come/first serve basis.
"Live chat is the closest thing to a house call because of the direct back-and-forth information," he says. "I get letters from people everyday saying that they worked just like a house call for them."
Greene also makes regular house calls for patients who have a tough time getting to the office.
"My first house call was for a set of quadruplets whose parent had a hard time getting all four of them to the office even for a well-visit, so I started stopping by their house on my way home from the office to do well-child visits and look for colds and flus," he tells WebMD.
"Then I began doing it for a number of families for whom it made sense," he says.
Greene brings a little black bag filled with a stethoscope, some other basic medical instruments and some medicines and examines his patients wherever the light is best in the home, he says.
"For a while, house calls were the most common type of visit, then they became almost extinct. Ideally they will become a part of every pediatric practice, but not the major part as the office is still the best setting because it has the best light and more medical tools than a doctor can carry in his or her bag," he says.
"Sometimes house calls end up being more convenient for me and the parent because we are closer to their home than my office so it just saves both of us time," says Anne Francis, MD, a partner at the Elmwood Pediatric Group, a group of pediatricians in various specialties based in Rochester, N.Y.
"House calls are not appropriate for a very sick child but may be good for something simple or for a homebound child who is in a body cast," says Francis, who's also a fellow of the AAP.
Asked whether pediatric house calls are a trend, she tells WebMD, "I am not seeing it in the Rochester area as a general practice for a lot of reasons including the need for specialized equipment and testing. If you have a very sick child, you may need modalities that you wouldn't be able to carry to the home."
Francis says she prefers the office setting to the home in case she needs to call in her specialist colleagues for help during an evaluation.
There are also some safety concerns for the doctor and the patient when care comes in the form of house calls, she says.
"There may be danger for a doctor who enters a home or an empty office with patients he or she doesn't know very well. There are also some unscrupulous physicians [who could take advantage of a patient because] there are no safeguards to monitor their behavior at the home like a nurse or a receptionist [may do at the office]," she says.
"We don't have any data to support that house calls are making a comeback other than what people have heard around the country sporadically," says Jack T. Swanson, MD, chairman of the AAP's Committee on Practice and Ambulatory Medicine and a pediatrician in private practice in Ames, Iowa.
"House calls are a practice preference among the people that are doing it," he tells WebMD.
He says there probably won't be a study on house calls unless it starts to become a common practice and there are concerns about reimbursement or other issues.
Swanson does not make house calls. "There is more availability in the office for evaluation and testing of sick children," he says. "But some children may have a difficult time getting to the office so there are two sides to the story."