Dr. Housecall

The image of the medical-bag-toting, small-town doctor making house calls to see familiar patients is a classic American cultural icon. But it’s also one that has been largely wiped out by high-tech medical offices and managed-care models. Still, the need for doctors-on-the-go remains, particularly for the housebound elderly. So, Dr. David Katz seized that niche in the market years ago, first by serving Foundation Health Medical Group clients at their homes and then, in 1997, by opening Housecall Medical Associates Inc. along with nurse practitioner Mariana Locke. They can be reached at 933-7209.

When did you first recognize the demand for house calls?

That happened a long time ago. I used to be a family physician in Dixon, and, at that time, there were only 4,000 or 5,000 people there. And, as a general practitioner, I realized that there were some of my elderly patients who just didn’t make it in for appointments. They’d have an appointment, and they’d miss it. Then they’d have another appointment, and they’d miss it. If I called, they’d say, ‘Oh, I just didn’t feel good today’ or ‘I couldn’t get a ride’ or whatever. Well, I was only five minutes from anyplace in this little town, so I just started going out on my bicycle with my bag on the back and did house calls once or twice a month, and it was fun for me. It was good to get out into the fresh air and see the community, and it was very much appreciated by my patients. That was back in the ‘70s.

Did you feel a connection to the doctors of old?

Definitely. I think the older doctors were perhaps less analytical. They were not looking at it sociologically; it was just the thing to do. Actually, at the turn of the last century, 90 percent of medical care was provided as house calls.

What changed that?

The advent of technology after World War II—X-rays, ultrasound, more extensive blood tests—made doctors feel as though they wouldn’t be providing up-to-date medical care unless they were in a setting where their patients could get those kinds of services.

What did we lose for that gain?

We lost the context that patients live in. We lost the information of what their lives are like after they leave our offices and fill their prescriptions. The context in which we live is a major influence on how the treatment works.

How do you mean? Can you give me an example?

I recall one patient who was not so old, 55 or 60 years old, with a really bad heart condition. And he kept falling. He also had trouble finding his medicine and taking his medicine and just seemed to be very disorganized and was frequently in the office as an emergency or ended up in the emergency room. When I went out to his home, it was just absolutely cluttered. His wife was disabled, and he was disabled, so neither of them could really pick up the clutter, so you couldn’t even walk from one corner of the room to the other and get around the boxes and furniture and the old food and so on. They were good people, and all we needed to do was get them some help to clean up so when he walked around his home he wouldn’t be tripping over things and falling, leaving his medicine somewhere and not able to find it. So, it made a big difference for me to be able to see that.

Is there a trend in the profession toward more house calls?

That’s correct. The American Academy of Family Physicians, of which I’m a member, has recommended it be part of the medical-school curriculum and also the resident-doctor curriculum. I’m not an internal-medicine specialist, but I believe their organization has recommended it, as well, because they see a lot of elderly patients. We need to know how to do house calls, so there is a movement to teach young doctors how to do house calls.

How has the managed-care system responded?

Well, managed care as far as home care is a two-edged sword because they, of course, don’t want to spend extra money on house calls that aren’t needed. But what we’ve found in Sacramento is that some of the more enlightened, forward-looking HMO administrators have realized that a house call is much less expensive than a trip in an ambulance to a clinic or emergency rooms. So, we’ve been getting more and more referrals from case managers at some of the major Sacramento HMOs to see patients and report back to their HMO doctor what’s going on, and how we can preserve a person’s health at home so they don’t end up in a hospital or nursing home.