"So how is it going?" I asked, trying to be conversational. Our new cleaning person seemed to be almost scowling as I passed her in the hallway. "I'm not so sure," she replied. Her response seemed odd for a first day on the job. But I didn't really know her, and attributed her demeanor to eccentricity.
Later on I saw her in the kitchen mixing a glass of soda bicarbonate. "Why are you drinking that?" I asked.
"My heartburn is acting up again," she said. "The stomach medicine my doctor is giving me doesn't help at all. This has been going on for months and it seems worse today. Between my stomach problem and my diabetes, I never get any peace."
"Please sit down--stop cleaning," I said. After taking a brief history and concluding that her "heartburn" was likely to be acute coronary syndrome, I picked up the telephone and told her I was calling an ambulance.
A look of shock transformed her face, and she said she couldn't go, refusing an ambulance in spite of my best arguments. But she did agree to see a doctor, so I called an internist I knew and asked him to see her right away. Then I called her sister, who agreed to drive her from our house directly to the doctor's office.
The internist did an EKG and hospitalized her immediately. My wife asked when she could come back to clean. "After her coronary bypass," was my reply. The sister, meanwhile, declared it a "miracle" that her sister had come to clean my house.
Indeed, this interesting twist on the traditional "house call" wound up being good timing, and nowadays it seems that getting any doctor to make an actual house call is a "miracle" in itself. Yet there are physicians in some areas who will do it, and in many cases it may actually be more cost effective than a trip to the ER. It certainly makes sense for older folks or others with limited mobility. Sometimes the mere convenience justifies the cost.
How do you find out about doctor house calls and other home services that may be available in your area? A patient advocate may be able to provide this information. There are also databases that list physicians who make house calls by region. You may need to be prepared to pay out of pocket, as many insurers do not yet cover this service. The good news is that most house call services (unlike most of the rest of health care) are actually prepared to quote you a price beforehand.
Mark L. Friedman MD FACEP FACP is an emergency physician working to revolutionize the delivery of health care.