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House Calls
Posted: 5-24-2010 2:49PM

This doctor visits patients in their homes.

 

By Chuck Hunt

Faribault County Register

 

Remember the olden days, when doctors carried little black bags and made house calls? Those days are long gone in the world of modern medical clinics, busy doctors and new medical technology.

Or are they?

One doctor at the United Hospital District in Blue Earth is bringing back those good old days.

Dr. Aaron Johnson is making house calls as part of his practice, and he even carries a little black doctors' bag. However, he also carries a laptop computer.

"Part of my training to become a doctor included a mandatory class on how to make house calls," he says. "I have always wanted to integrate it into my practice, and now I am able to do so."

It wasn't as easy to accomplish as it might seem. Several departments at UHD had to 'get on board' with the idea, in order to make it work.

For instance, all of the patients' charts are now digital and on computer. Hence, the need for the laptop.

"We had to set up a secure way for Dr. Johnson to access the hospital's data from a patient's home," says UHD Administrator Jeff Lang. "We were able to have our IT department get that set up."

Then there is the matter of billing, which includes getting insurance and Medicare payments for the at-home service.

But, it all came together, and Dr. Johnson has begun seeing patients in their homes. All of the visits so far have been to patients Johnson was seeing anyway. 

"The ones I am visiting would have great difficulty getting in to the clinic, especially with the winter we are having," the doctor explains. "It just doesn't make sense for a person who can hardly walk, or is in a wheel chair, coming in to the clinic. Why should they make an heroic effort to get here, putting themselves and their caregivers at risk, when I can easily stop to see them?"

If the patient is able to make the trip to the clinic, and the weather is good, a home visit may not be necessary.

But, Johnson says there are other advantages to making a home visit. "A patient opens up more in their home than in an exam room," he says. "They feel more comfortable about sharing what is on their minds."

Plus, Johnson says he can see what their home environment is like.

"They may tell me in the clinic that they are eating meals, when they actually are not," he explains. "In their home I can tell if there is food in the refrigerator or in the cupboards."

Johnson can also check for living conditions and safety. He says he can see if there are hazards such as unlit hallways, no handrails on the stairs, or loose carpeting.

"I can use the home visit as a great opportunity to teach," he says. " I might tell them something in the clinic that they will forget 10 minutes later, but when they hear it in their home, they take note of it."

August 'Gus' Katzke and his wife, Ellen, can't say enough about Dr. Johnson and his willingness to make a visit to their home.

"it has enabled us to have Gus stay at home," Ellen says. "Dr. Johnson is the most wonderful, caring man."

Gus suffers from congestive heart failure and COPD. He is on oxygen all day and night. He was at Parker Oaks in Winnebago, but really wanted to be at his home, near Delavan.

"Dr. Johnson said that if I was willing to do the daily care, he would be willing to make home visits to check on Gus," says Ellen. "I said 'yes,' and Dr. Johnson sent him home. It was wonderful."

Ellen daily prepares Gus' medications, checks his oxygen levels and blood sugar, and whatever else is needed.

Then, about once a month or so, Dr. Johnson stops in to check out Gus' lungs, blood pressure and other medical conditions, such as his swollen feet and legs.

"You really need to wear these surgical support socks," Johnson chided Gus on a recent visit, after noting he wasn't wearing them. "It will help reduce the swelling and get you back to walking."

"I've been telling him that, doctor," Ellen says.

Johnson made a deal with Gus that he will continue to visit if Gus wears the socks at least two days a week.

Whether a home visit is warranted is a 'balancing act,' Johnson says.

"The question is, who will actually benefit from having home visits," he explains. "Obviously I can't do this for all patients. I can't penalize my patients who make appointments to come to the clinic, so I have to decide who it makes the most sense to visit at home. It can be a time management issue."

Dr. Johnson's office manager, Sue Hassing, also points out another benefit for the home visits.

"Sometimes a visit to the home will reveal an impending medical condition," she says. "A home visit can prevent a need for a trip to the emergency room or hospitalization."

Sometimes Dr. Johnson needs to take patient samples, such as blood or urine, back with him for the lab to test. Just as would be done in a clinic visit.

"One more benefit to home visits is trust," Johnson says. "The patients build up a sense of trust in the doctor during house calls. This can really be beneficial down the road when some difficult medical decisions may have to be made."

But the biggest reason for a home doctor visit? Johnson says it has to do with happiness.

"Many people want to stay in their own homes, especially older folks," Johnson explains. "Having to go to a nursing home or having to make that heroic effort to get to the doctor, makes them anxious and unhappy."

He says when people are happy and content, their health improves.

"Their length of life, quality of life and health are all much better if they are happy," Johnson says. "If not, their health declines, depression can set in, and their immune systems can fail."

As the population ages, Johnson sees home visits as becoming more important.

"Seventy years ago it was the common way to practice medicine," Johnson says of home visits. "But doctors then saw three or four patients a day. Now they see many more, and it became a better use of the doctor's time to have the patients come to the doctor's office."

He wonders if the original way actually should have been abandoned as it was, or if it simply should have been altered.

Now, he gets a chance to see if the two systems of seeing - and helping - people with health issues can both be used.

"Sometimes the last thing a sick person needs is to risk their health getting to town to see the doctor and sitting in a clinic waiting room with a bunch of other sick people," Johnson says.

A home visit might be just what the doctor should have ordered.

 

Reprinted with permission from Faribault County Register

 

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