The Coral Gables Times

In his office, the doctor has better equipment than he can carry in his bag to help a sick child.

to come to the office instead?

PHOTOGRAPH BY WERNER WOLFF FROM BLACK STAR to come to the office instead? swallowed it yesterday afternoon. But I've been lying awake thinking, and I guess something ought to be done about it.'" Again, a doctor ruefully tells of visiting a new patient and noticing six bottles of medicine beside the bed. All had been prescribed by another local practitioner. The sick man said: "Sure, Dr. Jones was here just this afternoon. But I felt it might make sense to get another opinion." "Two years ago," reports a Los Angeles physician, "I answered an urgent call to a man who said he was in great pain. When I got out of my car at the address he gave me—in a quiet, and dark, residential street—I was knocked senseless. When I came to, I found my bag had been ransacked. Checking things over later, I realized that my agonized caller was a narcotics addict desperate for morphine." Drawbacks of house calls today From La Jolla: "I was once the fifth doctor to respond to a call to a pregnant girl said to be dying. She'd fainted from the pressure of a girdle she was too vain to leave off. The neighbors were extra helpful in rounding up medical aid." A doctor in Newton, Massachusetts, recalls: "My father practiced the last 20 years of his life wearing a spinal brace. He was driving home half asleep in the small hours when he smacked his car into a tree. A lifesaving journey? Oh, no. The patient had just had too much to drink." Doctors themselves are sharply divided on the pros and cons of house calls. Last summer, a headline-hitting debate on the topic was touched off by Dr. Phoebe Hudson, a pediatrician who has a suburban practice in Westwood, New Jersey. "House calls, for the most part, are as outdated as the horse and buggy," wrote Dr. Hudson in Medical Economics, a journal circulated to doctors only. "They're a leftover from the days when most people didn't have cars. Nowadays, they're just a bad habit that more physicians should break." Dr. Hudson backed up her opinion with these arguments: For one thing, she said, a house call is often a waste of the patient's money. In many cases, he still has to come in to the office later. If he'd come in the first place, he'd have saved money. Furthermore, house calls waste the doctor's time. "As long as patients come to me, I hum along on schedule," she noted. Doctors of two minds The clincher, in Dr. Hudson's view: House calls are medically unwise. "I can do a much better job in my office," she wrote, "where I can use my laboratory facilities, take an X ray if necessary, and even call in my partner for a free consultation." Was Dr. Hudson teeing off on patients—or, since she's a pediatrician, on parents? Not a bit of it. Her bolts were aimed at fellow physicians! "It's doctors," she charged, "not patients, who propagate the house-call tradition. Many M.D.s like to think of themselves as old-time practitioners—the type usually pictured stumbling through the snow to save a life. Any other image, they're afraid, will strike patients as too cold, too efficient. What these doctors don't realize is that most patients are pretty well-adjusted to modern times. And most of them wouldn't expect house calls if their doctors took time to educate them instead of answering every summons with 'I'll be there.' " Support for the embattled baby doctor was soon forthcoming. A Westchester, New York, doctor told The New York Times: "In my office I can see four, maybe five, patients in an hour. A house call can take me an hour and a half. Does it make sense, unless there is some reason why the patient shouldn't be moved?" And in the same newspaper on the same day, a physician in Fairfield County, Connecticut, said he believed "75 per cent of house calls could be treated, and probably better, in the office." Among the comments from other doctors: "I've cut down on house calls since I discovered that many of my house-call patients—even the elderly ones—were having no trouble getting to dinner, to church, or to visit their friends."—Dr. R. J. Lovett, Syracuse, N.Y. "When a parent gripes about the trip, I use this argument: 'If I decided your child had to be hospitalized, you wouldn't question my judgment, would you? Why question it about a house call?' "—Dr. Edwin Matlin, Garden City, N.Y. "You take your car to the garage because that's where your mechanic has all his best facilities. Why not bring the patient where the doctor has all his best facilities?"—Dr. T. J. Albertowicz, Richland, Wash. Not that those agreeing with Dr. Hudson had it all their way. Plenty of doctors said she was off the beam. Dr. S. M. Papperman of Paramus, New Jersey, wrote to his local paper, the Bergen County Record: "I have found that patients by and large are a pretty well-educated group and will ask for a house call when the patient is pretty darned sick and cannot go to the office easily." And another suburban doctor of long experience looked at it this way: "If you get a distraught mother on the wire and she thinks her child is terribly ill, even if you know he isn't, there's only one thing to do in my opinion—go." As the doctors went their busy ways, the battle raged on. Two of the more outspoken critics of Dr. Hudson's thesis wrote: "If more doctors would learn to use their five senses instead of calling for laboratory tests and consultations, they could do a good job even above the din of the average household. What's more, a doctor can learn a great deal about the patient by observing him in his home."—Dr. Julius H. Manes, Bennington, Vt. "Let's face it. Personal comfort and financial gain are the only things that stop most doctors from making house calls. The excuse that you can't examine a patient properly in the home is a lot of malarkey."—Dr. Frederick M. Walsh, Long Beach, Calif. Dr. Spock's view It was inevitable, perhaps, since the ruckus was triggered by a pediatrician, that the most famous baby doctor in the entire U.S. should be called in to umpire. A call went out to Cleveland Heights, Ohio, for the views of Dr. Benjamin Spock, author of the 13-million-copy best seller Baby and Child Care. Said Dr. Spock, in part: "There are sound reasons for seeing children in the office. But in the world their mothers grew up in, it was considered the right of a sick person to stay in bed and be seen there by his doctor. And mothers certainly expect this right for their children, whose protectors they are. The time to discuss the house-call issue with a mother is not during what she thinks is a crisis, but in the course of one of her first routine visits to the office. An overwhelming majority of people will respond quite reasonably to reasonable explanations." As a suburbanite, a parent, and a patient, I'd say the good Dr. Spock had summed up the situation correctly—and not only for tykes but for teen-agers, young marrieds, and older patients, too. The doctor does know best, but, if he's a wise man, he'll choose the right time to blow the whistle on you for calling him out. When you get to the heart of the matter, that's what most family doctors actually do. Even Dr. Hudson, who admits: "Sure, I make some house calls. Croup, convulsions, and certain types of accident bring me on the double. Sometimes I go out just as a favor to a special patient." So for all the argument, house calls are still being made, even in the far reaches of the suburbs—but only on doctor's orders. Suburbia Today, April 1962 9