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HOUSE CALLS

Dr. Veronica Lofaso and nurse practitioner Deidre Mole are preparing to see patients. There’s no overflowing waiting room, there aren’t even exam rooms filled with anxious patients. They leave their office to pound the pavement and visit patients in their homes. Dr Lofaso believes a doctor’s house calls can be a much more effective method of consultation than having the patient travel to the clinic.

“When a person comes into the office they are really just a diagnosis. A sore throat here, heart trouble there. During a doctor’s house call, the patient is seen as a person, since they are at home” says geriatrician, Dr. Veronica Lofaso.
According to recent data published in The New England Journal of Medicine, in 1930, 40 percent of all doctor-patient visits were house calls. By 1980, the proportion dwindled to less than 1 percent. In the 1990s the number of doctor house calls continued to drop.
But, physicians like Dr. Lofaso, who believe in doctors’ house calls, are trying to change that. She helped start a doctor house call program in her New York City community. She makes about 20 house calls a week and on most days brings along medical students and residents in internal medicine.
Doctors’ house calls can really help patients. Many of them are truly home bound, in that it is very difficult for them to even get past their door steps, they just literally can’t walk, they have breathing and heart problems,” says Dr. Lofaso.
Dr. Lofaso explains that the rising cost of medical care and insurance are in part preventing physicians from making house calls.
It is predicted that in the next 10 years, the number of people older than 65 years of age in the United States will increase by 10 million. Already, 2 million Americans are permanently housebound. In controlled studies, doctor house calls have been shown to reduce the rate of emergency room visits, the average length of hospital stays and the number of admissions to nursing homes. Some data suggests that doctors’ house calls might even prolong life.
For 92 year old Rose Orwasher, Dr. Lofaso and Deidre are real-life angels.
“She’s sensitive and very aware of what your problems are. She doesn’t push anything aside. She follows up any little complaint, and when there is a real emergency she is there for you,” says Rose.
Dr. Lofaso also does a safety inventory of the home during her visit.
“We’re always looking at carpets, electrical cords and lights, those are one of the biggest reasons people fall. We worry about food in the refrigerator as a sign as someone to really be able to get what they need.”
Both Dr. Lofaso and nurse practitioner Deidre Mole agree that they would not want to practice medicine any other way. “When you walk into someone’s home you walk into a life. I would love for the people in Washington to consider Medicare reimbursement that is reasonable for the time spent and the energy spent. Patients need it,” says Deidre.
Modern technology is also helping doctors make house calls. Portable devices that can measure blood oxygen, a device to administer electrocardiograms (EKGS) and wound-treatment equipment are now available.

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