Christine Chronicles

The Home Visit: A Lost Art

After my first rotation in psych and a medicine elective during my third year, I was really curious to see what a home care visit was like. The idea of an iconic old doctor toting their black leather bag to see a sick patient in home seemed something I only saw in the movies or heard about (e.g., Jay Parkinson).

I finally got a chance this past month. I am in my first rotation of my 4th year in geriatrics. I have always had a penchant for working with older adults. I worked in nursing homes and hospice, then eventually pursued a Masters in Public Health focused on gerontology. My first geriatric experience was growing up with my grandmother who had diabetes. I saw the daily struggle to achieve some sort of control of her sugars. I also saw the large family dinners, constant desserts and breads that she would claim to not eat in her doctors’ offices.

For the past few weeks in geriatrics, I’ve spent most of my time in outpatient clinics university clinics, VA clinics and in nursing homes seeing patients. I was fortunate to also visit elderly patients at home. It is strange being in someone’s home for a check-up and it is unlike anything ever learned in medical school. They don’t teach you how to deal with hoarders or with patients that immediately light up a cigarette as soon as their physical exam is complete.

A home visit is the closest thing to being a fly on the wall. In just a few minutes, you can see what a person really is like at home. Many patients come to clinic visits in their Sunday’s best, and tell you they take all their medications or are eating healthy diets… things they think you want them to say. Seeing someone at home, you can get a better sense of what their life really is like beyond their words. Before visiting a patient, I read through his previous clinic visit’s notes and saw in his social history that he smokes only 3 cigarettes a day and kept a vegetarian diet because of his high cholesterol. During his home visit, I saw his overflowing ashtrays and cartons of cigarettes, and watched his primary caregiver pour likely a half cup of salt on very fatty slab of meat (definitely not vegetarian).

The point isn’t that a home visit is to prove your patient is lying to you, but you get a true glimpse of how their environment and health behaviors may affect their health or treatment progress. It also provides an opportunity to help patients make everyday changes at home, whether it’s walking around the home pointing out hazards that may lead to falls or going through their multiple medications and helping them discard duplicates and expired meds.

I am grateful for this privilege to be allowed into someone’s home since it can be invasive. But, I do believe and hope that the small interventions or seemingly minor recommendations may help them long term.