In 78-year-old Connie Wolfe’s home in Brainerd, two doctors bend over her foot, examining a sore spot, as Mrs. Wolfe pats the sofa cushion beside her, beckoning Zeus, her gray cat.
Mrs. Wolfe, who set out a tray of chocolate chip cookies for the doctors’ visit, patiently answers their questions and demonstrates how she gets out of bed in the morning using a walker and how she gets herself in and out of the bath.
After the examination, Dr. Mukta Panda, interim chairwoman of the Department of Internal Medicine at the University of Tennessee’s College of Medicine in Chattanooga, said, “That’s the kind of information we get that we wouldn’t get in the office.”
Dr. Panda, joined by three internal medicine residents and a fellow College of Medicine faculty member at Mrs. Wolfe’s home last week, is leading an effort at the college to train medical residents to conduct home visits with their patients.
The project, which Dr. Panda has dubbed “Bringing Back the Black Bag,” is funded by a three-year grant from the Arnold P. Gold Foundation, a public foundation that supports humanism in medicine. The project represents a throwback to early half of the 20th century when family doctors regularly packed up their stethoscopes in sturdy black bags and headed to patients’ homes for check-ups, Dr. Panda said.
For Mrs. Wolfe, who has limited mobility on her right side after a stroke last year, a home visit is the only way she can see a doctor. The visits are a refreshing departure from the impersonal relationships she has had with doctors in her adult life, she said.
“With Dr. Panda, I have a very warm relationship with her,” Mrs. Wolfe said. With most of her other appointments, “I would hear (the doctor) outside the door saying to the nurse, ‘Now what’s her name? Who is she?’”
Building Trust
Home visits foster a sense of trust between patients and their doctors and provide the physician with details of their patients’ lives, such as potential barriers to compliance with doctors’ orders, that cannot be gleaned from a 15-minute office visit, Dr. Panda said.
“The intimacy of a house call can really be a window into a patient’s life,” Dr. Panda said.
A research study, also funded by the $24,000 foundation grant, will examine reactions from both the patients and doctors involved, as well as look at how many hospital visits were avoided by the time-intensive home visits.
College of Medicine faculty involved in the project hope the results will bolster efforts to improve doctor compensation for home visits, said Dr. Ann Rybolt, a geriatrician and UTCOM in Chattanooga faculty member who also is leading the study.
Relatively low compensation for primary care physicians means that many can’t afford to take the time to visit a patient at home and still keep their practices out of the red, Dr. Rybolt said.
The decline in house calls and the move to the doctor’s office appointments was, in many ways, based on practicality, she said.
Decades ago, most of a doctor’s crucial tools could fit in the black bag carried to patients’ homes. But the proliferation of new technology such as X-rays and laboratory testing made it more efficient for patients to come to doctors’ offices for appointments, she said.
Staff Photo by Allison Kwesell
Kathy Twombley, nurse with Continu Care, left, and Dr. Natalie Strelnikova, right, check-up on Connie Wolfe, 78, during a house call visit. Dr. Mukta Panda, the Interim Chair of the Department of Internal Medicine, at the University of Tennessee College of Medicine in Chattanooga and recently laughed a program called, "Bringing Back the Black Bag," to encourage residents to make traditional house calls.
For medical residents participating in the “black bag” project, the home visits are a return to what many of them imagined or hoped their careers in medicine would resemble, said Dr. Natalie Strelnikova, chief internal medicine resident.
Time constraints typically “leave very little time for human interaction. To me, home visits are some of the most rewarding times when you actually can connect” with a patient, she said.
The house calls remind Mrs. Wolfe of riding along in a Model-T Ford with her father, who was a family doctor, as he made house calls around Chattanooga in the 1930s, she said. Her father would write “prescriptions” for his young patients for ice cream cones and sodas at the nearby drugstore, she said.
“He maintained the kind of relationships these doctors now are trying to get back to,” Mrs. Wolfe said.
