Trade secrets of a house call doctor

Now that I am no longer the only doctor in New York City doing house calls, I figured I’d spread the wealth and teach some of you newbies on some secrets of house call medicine.

A good house call physician does two things better than any other doctor:

1. He (or she) answers the phone when called NO MATTER WHAT (this includes email, mms, text, vm–welcome to the 21st century–no need to make sure your horse is well fed so you can hustle off in your buggy.

2. Know how to improvise. Since we are only as good as our knowledge and the gear we carry with us, improvisation in clutch.

Further details to follow, off to administer cefepime IM to a patient with pneumonia (that’s right, I wrote IM or intramuscularly, not IV)–cefepime can be mixed in lidocaine and given IM with equal efficacy to IV form. And you then do not have to fuss with the IV and the drip and wait around for 30 to 60 minutes to run the drip–time is money. I am out of here?

WHY CHOOSING A DOCTOR COULD BE DONE BY A 6 YEAR OLD?

Let’s face it, children have good intuitions. As we age, these get muddied by things like co-pays, co-insurances, prior authorizations, long hold times on the telephone listening to recorded messages telling yo how great the doctor’s office is.

A 6 year old would know to ignore all this.

An adult seeking a new medical doctor for themselves or a loved one could learn a lot form simple childhood observation.

For example, we all know we should wash our hands and stay clean. A doctor with a dirty lab coat is a bad sign, stay away.

Another example: 6 year olds learn to read and write neatly. Bad sloppy writing equates with bad medicine. This is not just my opinion. This is shared by JCAH0 (https://www.jointcommission.org/) who insist on neat writing or electronic medical records, no medical jargon, no latin, and no abbreiviations.

Other examples I always look out for both as a doctor and patient:

  1. Is there a plate of security glass between me and the receptionist. If so, why? Do you really think I am going to steal your stapler or the multitude of redundant forms you are going to make me complete?
  2. When I call or email or text my doctor, does he answer the phone and get back to me in a timely manner? This sounds straightforward for a 6 year old but really, we live in the 21st century, a time of ultra-accessibility. Pick up your phones doctor and loose the pagers!
  3. Speaking of pagers, if you doctor uses one, he probably should be placed in a time machine like Back to the Future.
  4. My 4 year old daughter wants everything NOW. You know what, so do I as a New Yorker, especially when I am sick. If you doctor makes you wait for more than 5-15 minutes in the waiting room, then has their medical assistant put you in a paper gown and sit in a tiny room by yourself freezing for another 30 to 60 minutes, this is a bad sign–in fact, it sounds like you are about to be hosed down before entering prison!M FYI my office has no waiting room. The term is an oxymoron. Patients are seen on time. In New York City where space is precious, why dedicate so much of it to a room full of old National Geogrpahics that nobody wants?
  5. How many pages of redundant paperwork asking the same questions did your doctor’s office give you to complete. Plus, some offices also make you complete information on a tablet or ipad. Why ask me my name, birthday, and what medicines I am allergic to a dozen times. Makes no sense. My office paperwork is completed by my stafff so the patient only need sign their HIPPA medical record release and r=then we go right into practicing medicine.

More examples and good stuff to follow, be well.