Family Doctor Felix Obregon doesn't need to ask Viola Thompson if she's been watching her diet. Her airy kitchen still smells of the morning's cooking.
"No more bacon and eggs", cautions the doctor as he examines the patient in her Chicago apartment. "I've told you; it's bad for your cholestorol".
Thompson, 79, is one of 10 patients Obregon will visit this day. She started getting house calls after a few falls prevented her from driving to her monthly check-ups. The doctor briefly consults with his patient, who is clearly sorry to see him leave.
Obregon is part of a new wave of physicians who have discovered a welcome relic; the house call.
Old fashioned? Hardly. Today's house doctors use sophisticated tools, some the size of a hand-held calculator, to perform everything from blood tests to electrocardiograms. Best yet, the house call seems to have created not only a healthier patient, but a happy doctor with an income that could rival an office-bound counterpart's, say house-call experts.
"I couldn't give patients the time they needed when I was seeing 35 or 40 children a day", says pediatrician Andy Hartman, 51, who left a large group practice in San Jose, California, a year ago to specialize in house calls. "Now, you spend maybe an hour with six, seven, eight patients, answer questions, really 'be there' for them. A lot of doctors aren't happy getting 35 to 40 patients pushed down their throats, rushing things, making mistakes. They know it's not what they were trained to do".
Nationwide, doctors made more than 1.4 million house calls to Medicare patients alone in 1998, says the American Academy of Home Care Physicians, which predicts a jump in the numbers this year. Meanwhile, more medical schools are incorporating the long-forgotten house call into their curricula. Physicians are even building pratices around it.
"This is about proactive medicine. You're taking care of the patient as a whole," says Obregon. "I see a real need for house docs. Who knows? Maybe this will become a specialty in the future. Last summer, he joined the Chicago office of Mobile Doctors, which calls on more than 7,000 patients in Illinois, Michigan, Indiana and Florida.
What's driving this sudden swell of home-based medical care? Quite simply: money and technology. Medicare upped its reimbursement rate to physicians for house calls in January 1998. Now, they're paid 30% more for seeing a patient at home than in the office. Meanwhile, once-cumbersome medical machines now fit neatly into a doctor's black bag.
"This is not a 19th-centry house call", says George Taler, 49, president of the American Academy of Home Care Physicians. "We are providing 21st-century medicine in the home environment. And we find people are more accurately assesed in the home. "The office setting is always a proxy. In an office, one of the first questions we ask is, "How are things at home?"
This is a USA Weekend article in July 1999, outlining the modern "virtual" world where doctors make house calls.