European Stars And Stripes (Newspaper) - July 19, 1986, Darmstadt, Hesse                                Magazine the return of the House Call Kaa Plaa of toi and Luna or Patricl bin my a Touw Catt a South Boron. By Rob Stein United press International the doctor s House Call once nearly As exl incl As the horse and buggy appears lobe making a comeback. Increasing Competition among doctors new technology and the aging population have combined to help resurrect the once common practice. There was a Lima when everyone said the House Call was dead said or. Samuel Warburton an associate professor of Community and family Medicine Al 0uke University medical Center. But House Calls in Many respects Are making a  the House Call was relegated to nostalgia during the 1960s by a combination of several factors. Advances in technology Hal required the use of non portable equipment for diagnosis and treatment made Many doctors feel unable to provide adequate care in the Home. There was a time when virtually everything you needed was in your Little Black bag said Warburton. The technology was now in the office and the  and a shortage of doctors prompted physicians to open centrally located offices thai offered easy Access to Large numbers of patients. By staying in the office instead of spending time travelling a doctor could serve More patients. Medicine went through a period when the physician was real Busy said Warburton. There was an under Supply of doctors. A physician could see four or five patients in an hour in his office but if he went out on House Calls he could Only see one of  As Medicine became specialized fewer patients depended Solety on one general prac finer. The sick would often be referred to specialists they did t know who practice Only in their offices. Several new trends however have begun to make the House Call More popular again. An increase Hith number of doctor especially in Urban areas is forcing physicians to be More competitive. Young doctors trying to establish new practices offer House Calls As a marketing toot to attract patients Wise physicians Are realizing that the House Call May give them a marketing Edge said or. Jay Siwek. A family physician who teaches at Georgetown University in Washington and has researched the use of House Calls. Also Many of the increasing numbers of the elderly Are housebound with chronic or terminal illnesses. Without a House Call they would either have no care or have to ride an expensive ambulance loan emergency room. The woman i made a House Cali on today is an 88-year-old woman who would be in a nursing Home if i did t see her at Home said War Tourton. Government efforts to Cut the Cost of medical care encourage Shorter Hospital stays. After discharge Many patients require follow up care and May be unable to leave their Homes easily. The increasingly popular prepaid medical service programs known As health maintenance organizations or mos also encourage Short Hospital slays in favor of less expensive Home care. There s an awareness on the part of physicians that the medical political forces Are shifting out of the Hospital and into the  said Siwek. And just As advances in technology first worked against House Calls More recent innovations have allowed doctors to take technology Back into the Home. What we can do in the Home in 1986 is much greater than five years ago said Warburton. In the past for example patients had to Check into a Hospital to receive intravenous Antibiotic treatments. Such treatment can now be safely administered in the Home. Portable a Ray machines can serve As preliminary diagnostic tools. Simple blood analysis can also be done bedside. Most physical therapy including traction for Back injuries can now be done at Home. Visiting nurses nurse practitioners and Many family physicians never completely slopped doing House Calls. Bui Bill delay of the american Academy of family physicians said More family doctors have begun offering the service and most training programs for family physicians now include instruction on How to conduct a Home  doctor in other to Ciau a such As paediatrics and internal Medicine have increasingly also begun offering House Calls and others May follow. I d Kwe to see psychiatrists and Ortho pudists Start making House Calls said Marburger. Saying the elderly especially could Benefit from orthopaedic treatment at Home. No one is quite sure exactly How Many doctors Are performing House Calls. Bui the demand for the service has spurred the establishment of special House Call services nationwide. Job the medical care inc. In Portland. Ore., has been dispatching doctors to Homes for eight years serving Pri Manly elderly housebound patients. For these patients if it weren t for our service Many would t get any kind of medical care said cute Jameson who coordinates the service. Jameson said she considers the House Call a last resort. If patients can go to the office they Are encouraged to do so. Whenever we find a patient who is ambulatory and it would be better for them to get out we will refer them to a regular doctor she said. The House can service which usually responds to about 10 Calls a Day. Is also careful not to take business away from doctors in regular practice. It s a very political Type of service said Jameson. There Are a lot of physicians in the United slates today. There Are not enough patients for the number of doctors. That s one of the reasons we Are very cared not to steal patients Solo  to new York. Doctors on Call answers about 3,500 Calls a month from a much More varied clientele. "ft3 a mixture of  said office manager Elizabeth Devalle. We have a lot of elderly but we also have the Young professional who does t want to take time off of work to go to the doctor and parents with children Al Home. Or maybe someone who just does t feel Tike going  Delvalle said her service does t make judgments and also works with doctors who give their patients the service s number to Call in Case they can t be reached. A lot of people today also Don t have a family doctor. They Don t feet they have a need for a family doctor and then All of a sudden they get sick and Call us she said. The average be for a House cafe is �50, compared to an average office visit fee of $35 or close to $100 for emergency room treatment she said. While the Cost of a House Call is lower than a Hospital visit it is higher than a regular office visit. And while medicare and some private insurance reimburse doctors for House Calls the amount is usually the same As for an office visit. For Many private practitioners funding is still a big Issue in whether or not they can afford to make House Calls said or. Patricia Barry who teaches Al Boston University school of Medicine and makes House Calls to elderly housebound patients. Other doctors also caution that House Calls can be abused. There is no question that the House Call has a particular purpose and should not be abused by the physician or the patient said delay of the family physicians group. There is no question that when the patient is in a position to come into the office it is much More effective As a patient encounter because the doctor has at his fingertips the diagnostic equipment and support personnel that make for a More effective  saturday july 19, 1966 the stars and stripes Page 13