When I was very young, safe in bed with the usual flu or the occasional chicken pox or other standard childhood disease, I would dread the doctor’s tread on the stairs and the opening of his little black bag, which seemed vast to me. It was made of thick black leather and smelled of medicine and disinfectant—just like his office did, the one with the transom window above the door, the tiny uncomfortable wooden chairs, and the table with a map of fairyland on it that looked ancient even then.
He was a small man, our pediatrician. But I was even smaller, and he was scary, without the jovial bedside manner common to the genre nowadays. He had a tiny, trim mustache, and when he gave shots—and he gave them quite readily—they hurt.
But he made house calls. Any time my brother or I were sick enough to stay home from school, we knew we could not avoid his visit.
By the time I was the mother of a young child the house call was a thing of the distant past. When my son had a fever of a hundred and four, it was necessary to haul him, bleary-eyed and runny-nosed, coughing up a storm— often out into a storm—to sit in a waiting room with other sick children in the sick section, separated from the “well child” group by only a few feet, to endure the glares of the mothers sitting there.
But now, according to the NY Times, the house call has been revived—at least, that is, for the rich. Catering to the traveler and business customer, but available to all who can pay the very substantial out-of-pocket fee, there are those who have filled what is now a specialty niche in the medical service world.
There may not be continuity of care, but for most people that’s long gone, anyway. Just as people are willing to pay big bucks for personal trainers and other sorts of TLC, they are eager to pay for a doctor who will come when called, the black bag (metaphorical at this point?) sometimes supplemented by modern devices such as portable ultrasound machines.
Most of us, of course, can hardly afford the service that was standard in my youth. In those days, the main reason it was so commonplace is the same reason medical care in general was affordable: it was all paid out of pocket, and it consisted of very low-tech care. Immunizations were key, but they weren’t very expensive. For the rest, mostly the doctor came, looked at the patient, dispensed a few pills or maybe the (usually quite useless) antibiotic shot, and waited for the sick to get better.
Which usually occurred. When it didn’t, the doctor came to monitor the progress towards death. Every now and then there was an operation—the appendectomy or the hysterectomy or other ectomy. But mostly it was watchful waiting, which didn’t cost all that much.
Now we have MRIs for every sprain; CAT scans that can visualize our insides; and advanced cancer therapy undreamt of in my youth, when the words “you have cancer” meant “you will die soon,” and therefore were usually not even uttered in front of the patient.
Some of this represents an advance, but some does not. Some of it merely extends the length of life at the end of life, when there’s hardly any quality left and even the patient would rather go gentle into that good night, but isn’t allowed to.
We pay for the privilege of high-tech care, and in most cases we don’t want to give it up. But it’s the reason the health insurance crisis is not really fixable, and the house call is a privilege for the very rich.