Once it was a staple of the American landscape ”“ the doctor making house calls, black bag in hand, informing the family that little Johnny would be all right or that (gulp!) Grandpa wasn”™t going to make it.
Today, the house call has gone the way of Sunday blue laws. Or has it? With an elderly population and the demand for home care increasing, there is a small but determined band of doctors who are keeping a venerable tradition alive and well.
Peter Foley Rizzo, a past president of the Westchester County Medical Society, sees this as part of a health-care trend to get patients out of the hospital as soon as medically feasible.
“Patients are recuperating at home,” said Rizzo, an orthopedic surgeon in Bronxville who makes some house calls, “and physicians are identifying the need to be out there and spend more time with their patients than they would in the office.”
Among these doctors are Putnam Valley internist/wound-care specialist Daniel J. Bonomo and White Plains podiatrist Bryan B. Kagan.
If being a physician requires equal parts skill and compassion, doctors who make house calls seem to have an extra dose of the latter.
Not surprisingly, it was compassion that led both Kagan and Bonomo to their callings.
Kagan remembers an elderly patient named Elizabeth, who had a bad foot infection, which he took care of. When he next saw Elizabeth, however, the infection was back.
“She started crying and said she had to wait for her son to bring her in since she couldn”™t afford the taxis,” Kagan said. “I said I was not going to let her foot get infected again.”
So he started seeing her at home, and soon some of Elizabeth”™s homebound friends and acquaintances.
That was roughly 30 years ago, and Kagan ”“ who also has an office practice ”“ has been making house calls ever since for approximately 100 patients on two mornings and one afternoon a week, with an occasional weekend thrown in.
Bonomo is strictly a mobile doctor, traveling to patients throughout Westchester and Putnam counties from 8 a.m. to 7 p.m. for 15 years.
When people think of wound care, they think of gunshots and other traumatic wounds, said Bonomo, who was part of the first wound-care center in the northeast as a resident at Mount Vernon Hospital in 1988.
But many wounds are chronic, the results of bedsores and leg and diabetic ulcers. When patients stopped coming in to the hospital for treatment he knew they still needed attention. Bonomo, who also worked at St. John”™s Riverside Hospital in Yonkers, packed a bag, got in his car and sought them out.
“It opened up a whole new world,” he said. “I got to see a whole lot of stuff I couldn”™t see in the office ”“ what they were sitting on or lying on, what”™s in the fridge” ”“ mundane things to the layman but vital clues to care for a physician.
According to articles in The Washington Post and the journal Clinics in Geriatric Medicine, house calls in the United States have declined from 40 percent of all doctor-patient visits in 1930 to one percent by 1980.
Bonomo ”“ a child of the ”™60s who remembers his pediatrician coming to his home to give him injections ”“ said that technology, necessitating office or hospital visits, is but one of the reasons for the decline.
“Another thing is the lawsuits,” he said. “The number one reason doctors are sued is a missed diagnosis, so they order up tests.”
Plus, he says, “it”™s not cost-effective. A doctor can make more money seeing eight to 10 patients a day in the office rather than two or three (at home).”
House calls also mean the added expenses of gas and car maintenance. Bonomo keeps his practice straightforward and his overhead low by seeing only Medicare patients and traveling with one assistant, Sherma Gruyon.
Despite the long hours, travel expenses and inconvenience, it”™s clear that there”™s something deeply satisfying for physicians in connecting with patients in their own homes.
“These patients were young at one point and vital, and it”™s sad to see what has happened to them,” Kagan said. “A lot of the time they have no one to talk to. You become like the bartender on ”˜Cheers”™.”
And that”™s fine with these doctors as it helps in the healing process.
“You get better compliance with your patients,” Bonomo said, “because you have a long-term relationship with them.”
