Response: Re: Home Visits and the Social Context

To the Editor:

We read with great interest the letter by Dr. Frey¹ who states that house calls help to “remedy the social ignorance of physicians about the lived lives of our patients.” We could not agree more. Part of the inspiration for our study was one of the authors (LP) taking a house call elective as a medical student with the other author (SL). During the elective we traveled to neighborhoods both poor and rich, to homes with well-manicured yards, and to those with refuse lying around. Every doorway we crossed offered new insights into the lives of our patients and, as Ian McWhinney² so eloquently stated, “we could see the history and dreams of our patients on the walls”. We witnessed the struggles of both the patients and their family members to achieve the best care they could in their situation. In some houses the pill box was easily located, schedules of home health nursing and physical therapy appointments were available, food was in the refrigerator, the house was clean. In others, medications were disorganized, with empty bottles begging to be refilled, and urine stains were evident on the couch from when the patient did not have help to get up. The Japanese residents mentioned by Dr. Frey were correct in saying that a physician can never truly understand their patient’s lives unless they make house calls. As family physicians wrestle with practice transformation and ascending the levels of the patient-centered medical home, we hope more physicians take the ultimate patient-centered step by driving to their patient’s home to better understand and contextualize the lives and choices faced by our patients.