A generalist's place is (also) in the home.
Regardless of how many generalist physicians we eventually have, patients will not get the treatment they need if doctors continue to work without house calls. For decades, patients have been coaxed out of their sickbeds to report to emergency rooms during "off hours," and once in the emergency room they are part of high-tech, test-driven health care. Only a return of the house call by the personal physician can reliably forestall this protocol-driven excess. There are obstacles aplenty to reviving the house call: few teachers survive who can teach this art; doctors now consider the house call burdensome work; present payment does not cover the costs; and doctors won't be safe on the streets at night. Some bureaucratic changes will be needed, of course, but most changes have to do with skills and attitudes. Care in the home is appropriate for many acute illnesses and chronic conditions. Patients need it, and doctors should provide it.
Greengold
M C
MC
Northridge Family Practice Residency Program, CA 91325.
D004630:Emergencies; D005194:Family Practice / Q000191:economics; D005251:Fees, Medical; D018166:Health Care Reform; D006792:House Calls / Q000191:economics; D006801:Humans; D014481:United States