Transforming Primary Care One House Call at a Time

Editor's Note: A two-part documentary, Rx: The Quiet Revolution, will air on PBS beginning on April 2 (Check local listings). Reflecting on his physician father's practice and the move away from hands-on care in contemporary medicine, the documentary's award-winning director, David Grubin, highlights a range of innovative practice models from Maine to Alaska. Medscape asked a number of our experts to preview the film and offer us their reactions and opinions about how well the documentary depicts the healthcare system as they know it and live it.

In this commentary, Kenneth W. Lin, MD, MPH, associate professor in the Department of Family Medicine at Georgetown University School of Medicine, offers us his perspective.

Hi. I am Dr Kenny Lin, a family physician at Georgetown University School of Medicine in Washington, DC.

When I was accepted into medical school almost two decades ago, I remember being given a stethoscope, which I still use, and a little black bag to take along when making house calls. Watching Dr David Loxterkamp make house calls in the documentary film Rx: the Quiet Revolution, and seeing him carry around a black bag that looks remarkably like the one I have, makes me a bit nostalgic, because it has been more than 10 years since I have actually made a house call myself.

I still remember the house calls I made: going to patients' homes, seeing whether they were actually taking their medications, looking at the stack of bottles on the dresser and comparing them with whatever medication list I happened to have for them, being able to talk to them, being able to comfort a patient in hospice who was experiencing pain. This is truly the stuff of primary care.

I believe Dr Loxterkamp's practice in Belfast, Maine, exemplifies the best of primary care: making relationships and improving health through those relationships while empowering patients. It is a reminder that the healthcare system is not meant for the benefit of the doctors, or the benefit of hospitals, or to make patient care convenient for us.

Transforming Healthcare Through House Calls

As we transform the current healthcare system, we have to look at what already works and how we can support that. How can we enable doctors to make house calls? The reason I have not made house calls is not because I live in a big city. It is primarily because it does not pay. It is difficult to leave the office, spend time commuting, and be paid no more than you would for an office visit, even though that service in the home is so much more valuable than bringing the patient to your office. In the office, you cannot get as much of a sense of who your patients are and what motivates them, and whether what they tell you squares with the reality of their living conditions.

I found this segment with Dr Loxterkamp inspirational. It reminded me that all primary care physicians—especially family physicians like Dr Loxterkamp—are sharing the same struggles: trying to motivate patients, and trying to deal with all the chronic disease epidemics confronting us, including obesity and diabetes. But it also reminds me that we have to support that kind of care through policy. We have to make it financially feasible. We have to encourage more talented medical students to go into these types of practices in both rural and urban communities, where there simply are not enough primary care doctors to be making that kind of difference.

That is my reaction to this excellent segment, and I look forward to seeing the rest of the documentary.

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