After years of evolution, the health care delivery system is slowly returning to its roots: house calls. In the 1800s, ailing patients remained at home, waiting for the roaming doctor to arrive via horseback. By the mid-20th century, home visits were abandoned in favor of bringing ill patients to the doctor’s stationary office. Fast forward to the 2020s: The ubiquitous nature of technology, paired with looming physician shortages and climbing health care costs, is bringing us full circle via telemedicine house calls. Along with the highly touted benefits of in-home virtual visits, clinicians have found that this method provides information about the patient’s home environment that is often overlooked during traditional office visits. This additional insight can be a major factor in designing an appropriate treatment plan that accounts for the daily obstacles presented in the patient’s home.
Despite the speed of today’s travel options, old-school home visits are no longer feasible. Clinicians cannot reasonably travel to each patient’s location; that precious travel time would be better used to meet with other patients instead. However, with the adoption of telemedicine technology and the massive demand for smartphones with video capability, savvy physicians have found a new niche with unexpected benefits: telemedicine house calls. This approach allows the patient to conveniently remain at home while the physician stays at the medical office—all while conducting a medical evaluation in real time. When the clinical assessment relocates from a sterile exam table to the patient’s own territory, providers are finding that patients tend to feel more comfortable and less stressed, as suggested by data indicating that blood pressure values frequently rise in a clinical setting, compared to being at home.
This glimpse of the home environment helps the physician gather a fuller, more accurate picture of the patient’s day-to-day life and how it may be affected by medical conditions. For instance, peeking in a patient’s fridge offers insight into the patient’s diet and nutrition. Thermostats can be checked to ensure they are set appropriately, to confirm that the heating and cooling system is functional, and to make sure the patient is not overcompensating for symptoms by keeping the thermostat at an unusual setting. For patients with limited mobility, the physician can examine the video’s background for potential tripping hazards and adequate railings. For children, tell-tale signs of everyday life can reveal much about the child’s personality and activity level; the clinician can witness the child’s social interactions with siblings, playmates, or family pets. In addition, when the provider is able to survey the patient’s medicine cabinet, he/she can deduce the patient’s compliance level and the effectiveness of the current medication regimen.
However, not everyone welcomes telemedicine house calls. Critics have pointed out that some patients may not want the clinician to see his/her private home life, sometimes because they feel self-conscious. In addition, patients may not have access to a reliable internet connection at home that can maintain the video call. As a result, these segments of the patient population are more likely to schedule in-office visits than telemedicine visits.
On the other hand, having a smartphone or tablet enables just about anyone to have a virtual visit; for this reason, some advocates predict that adopting telemedicine house calls will, overall, equalize access to care for patients in different socioeconomic and ethnic groups.
Nonetheless, the current pandemic is forcing many patients to rely on telemedicine whether they like it or not; the alternative is to head out and chance exposure to COVID-19—an unacceptable risk for those who are immunocompromised or who live with chronic health conditions. So far, the emergency measures enacted earlier this year in response to the pandemic have made telemedicine a practical, timely, and financially viable method for patients and providers to connect. Whether those measures will remain in place beyond the COVID-19 emergency situation is already being debated; the final results will determine how eagerly clinics, hospitals, and other facilities invest in telemedicine systems. In other words, these regulations will shape the future of telemedicine house calls.
To read more about the unexpected side effects of telemedicine house calls, click here.
To learn about how telemedicine house calls are benefiting older adults, click here.
To read more about the public health aspect of telemedicine home visits and how to help patients prepare for these consults, click here.