House Call: The Foundation of American Medicine and Its Resurgence

by Matthew Gibson, MA

In March, 1940, Dr. Harry Chambers was called to the home of eleven-year-old Timothy Scheffer. “Little Timmy,” as he was known, had developed a “terrible cough and chills” several days before, and, more ominously, a bright red rash had emerged on his back earlier that day. His mother feared the worst. Dr. Chambers arrived at the Scheffer’s house about 4 o’clock in the afternoon and examined Little Timmy. It was nothing to worry about, he assured Mrs. Scheffer. Timmy just had a mild bacterial infection—nothing a little bit of medicine couldn’t fix. The rash was merely a heat rash caused by the several blankets Mrs. Scheffer had piled onto her son in an attempt to relieve his chills. Within a few days, Timmy was feeling better and, much to his chagrin, had to return to school. There was nothing extraordinary about Timothy Scheffer’s case. In fact, Dr. Chambers, like thousands of other doctors across America at the time, made house calls such as these quite frequently.

Up until the mid-1950s, house calls accounted for about 40% of all patient physician interaction. There are literally thousands of historical examples of doctors treating their patients outside of a “doctor’s office.” While many doctors had an office, primary patient care was more likely to be given at the patient’s home, especially before the 1870s. Hospitals are by no means a new invention, yet only recently has the idea of the hospital been merged with the idea of the doctor. Prior to the mid-1850s, doctors were most often what we would now refer to as “administrators” in hospitals, they set general care guidelines but offered very little in terms of actual patient care. It is no surprise, then, that many people regard the house call as the foundation of the American medical profession.

Since the 1950s, however, the number of house calls made by traditional medical professionals in the United States has fallen off to less than 0.5%. Those individuals who still remember this old-fashioned practice often lament its demise. It is hard to understand why such a popular practice has declined by such a large extent. There are a few reasons that can be pointed out. First, the advancement of medical technologies brought with it large, expensive diagnostic and treatment machines that required centralized storage and use. It became impossible to use such equipment in a patient’s home, meaning that the patient had to schedule appointments at hospitals and doctors’ offices for certain tests and treatments. This shifted the focus from patient care at home to patient care outside of the home. Secondly, at the same time, doctors were learning more and more about fundamental biological processes. This new scientific knowledge led to a marked increase in medical specialization, which further shifted the site of care from the home to the office.

Recently, however, the house call has begun to experience a comeback of sorts. More and more primary care providers are realizing the potential benefits of treating patients at home. Patient care tends to be more focused on individual needs, and treatments are more tailored to the patient. Additionally, patients are typically more satisfied with the level and quality of care they receive when they are treated at home. Ironically, the same type of technological
advancements that shifted patient care from the home to the office may now
provide a way back. The digital revolution has led to many changes. Bulky, awkward medical machines have largely been replaced by smaller, lighter, more accurate computerized ones. For instance, x-ray machines that once weighed thousands of pounds and required a whole room for storage now fit conveniently in the back of a minivan. Other digital diagnostic tools do not require vast amounts of energy and can now be performed quickly in the field. Digital prescriptions can be uploaded directly from a physician’s computer to nearly any pharmacy, anywhere in the United States, all at the touch of a button. The relative low cost of digital machines make them a very attractive purchase for doctors, as well. For these reasons, it seems very likely that the future of American medicine will be found in the resurgence of an old-fashioned practice —the traditional house call of Dr. Harry Chambers and his bygone era.

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