Are There Challenges To Rising Home Visiting Doctor Services?

Now, it is increasingly becoming common for private doctors to offer home visits, or “house calls” for patients who need to see a doctor as soon as possible, and prefer the convenience and comfort of a doctor at home. This trend has been particularly noticeable in London.

Are Home Visiting Doctors Becoming Popular Again?

The landscape of home visiting doctor services has changed over the last 50 years. Back then, nearly 40% of consultations between physicians and patients were accounted for by house calls[1]. Skip to 1980 and only 0.6%[2]were house calls. Family physicians – or GPs as in the UK – have switched to in-office appointments over the years mainly due to increasing patient load[3].

This is a real dilemma when it comes to longevity planning and personalised medicine – two very real and fast-growing areas in medicine globally. Whilst this area in medicine is not fully developed in London, it is coming very soon and one of the key ways to deliver on this promise is by placing great emphasis on the patient’s relationship with their family doctor. This almost sacred relationship has perhaps gotten lost or forgotten over the years, and it was just over 20 years ago that a doctor in Seattle realised this and decided to become that familiar, reliable and personal family doctor to patients again. He also drastically reduced his patient load in order to offer this by charging an annual retainer fee to those wishing to remain registered with him; creating concierge medicine which has become increasingly popular over the last 2 decades. He offered his patients home visiting GP services (along with on-call doctor service) 7 days a week, 24 hours a day, coupled with highly comprehensive health assessments and longer appointment lengths. Both proactive and reactive care were provided in a more caring, personalised and efficient way[4].

The Key Challenge of Rising Popularity of Concierge Medicine

Concierge medicine is a phenomenal area of healthcare, but there are still some key challenges. Whilst it is fantastic that doctors are beginning to focus on individualised patient relationships, personalised healthcare and prevention, it means that they must restrict patient loads in order to offer this high calibre of service which includes house calls and more. Globally, this means we must encourage more people to apply for medicine, but to also engage themselves with family medicine. Even the doctors must change their mindsets and look at each patient as an individual; which may start with concierge medicine but should end with a meaningful transformation of the definition of GP, family doctor or even family physician.

The Key Challenge Of Increasing Numbers of On Call Doctor Services

Many doctors today wish to work like this in London, and therefore engage themselves with on-call GP services, but it must go deeper than just wishing to spend more time at an appointment. It is important not to look at house calls in the 21^st century as “Uber for doctors” – a quick fix cure whenever something goes wrong with a different GP each time. Similarly, we do not wish for private GPs to be looking for a quick buck and simply “a comfortable earning for a comfortable life”. They need to think bigger and more about the meaning of medicine; otherwise it does not teach our GPs – nor does it transform their noble career – into becoming real family doctors who focus on prevention and personalised medicine; doing their best for each and every patient they have the privilege to get to know. We always talk about the future being about prevention rather than cure – but the future is here and it means changing incentives for medical students as we need more private GPs focusing on prevention, and fewer specialists focusing on cures.

References

[1]Starr P. The Social Transformation of American Medicine. New York: Basic Books; 1982. Accessed via: https://academic.oup.com/biomedgerontology/article/56/10/M603/584909

[2]Driscoll CE., 1991. Is there a doctor in the house?. Am Acad Home Care Physicians Newsletter. Accessed via: https://academic.oup.com/biomedgerontology/article/56/10/M603/584909

[3]Butcher L. 2018. The Rise of House Calls. Patient Care; Trustee Archives.  Accessed via: https://www.trusteemag.com/articles/1354-the-rise-of-house-calls

[4]Tetreault, M. 2015. The History of Concierge Medicine in America (1996 – Present Day).Concierge Medicine Today. Accessed via: https://conciergemedicinetoday.org/the-history-of-concierge-medicine-in-america-1996-present-day/and https://en.wikipedia.org/wiki/Concierge_medicine