House Calls

As modern medicine has become progressively more scientific and impersonal, increasing numbers of patients are complaining: "I can't get my doctor to make a house call." To test the validity of the complaint, Medical Economics polled a sample of the nation's 153,000 practicing physicians, got replies from more than 1,200. As expected, general practitioners make most of the house calls (75%). Next come internists (almost 13%) and pediatricians (about 6%). General surgeons make less than 3%, obstetricians and gynecologists just over 1%.

Within each group there is tremendous variation. Though 99% of G.P.s make some house calls, the number ranges from as few as one a week to as many as 77 (racked up by a 70-year-old Pennsylvanian); the median is twelve (ten daytime, two at night). A majority of the polled physicians reported that they try to talk their patients into visiting the office because facilities for examination are better there, and the patient can usually be seen sooner.

But many doctors held out for the advantages of the old-fashioned home visit, pointing out that the family setting tells a great deal about the patient. Nearly all physicians try to avoid calling on obvious cranks, drunks who become remorseful in the middle of the night, and narcotics addicts; nearly all eventually make the call if there is any doubt in their minds as to the urgency of the case.

As for the propriety of outright refusal, a Montana practitioner took one extreme position: "A doctor's justified in refusing at any time he doesn't want to serve the patient. We're no more obligated to give service than is the grocer." A Michigan M.D. replied: "Nothing about medicine is as impressive to the layman as our willingness to get up and go out at midnight. Doctors must maintain their reputation on this score."

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