House calls are making a small comeback, as hospitals discover they can provide better treatment for a lower cost by sending teams of doctors, nurses, social workers and others to patients' homes after they have been discharged, The New York Times reported recently.
But there was a time when house calls were a common way to deliver medical care -- particularly at night, and especially in low-income neighborhoods of major cities. How do I know? My father, Leslie H. Bernstein, now 79, used to make them. I asked him how it worked.
Few of us are still around who practiced medicine this way, but it wasn't uncommon from the 1950s through the 1980s, when medical residents earned anywhere from zero to $300 per month, to supplement our incomes this way. We would cover answering services for older physicians or county medical societies. Since we commonly spent large amounts of time in busy hospital wards and emergency rooms during the day, we knew we could handle most situations and so did the physicians we covered for.
In the Bronx, where I worked, doctors would sign their patients out to us or the medical society, and we would be on call until the next morning. (We never told the hospitals that employed us, which had strict rules against outside work written into our contracts. Poverty, however had other dictates).
We charged $7 before midnight and $10 after -- cash only. Our cars were not air conditioned in those days, so the snap of thermometers breaking in our pockets during the summer was not unusual. We carried narcotics in our medical bags, and junkies and muggers knew it, so the threat of being robbed for drugs or cash was very real. If a call came in from a pay phone, we told "patients" to have a priest or pastor meet us at the address. I knew two doctors -- one of whom had been mugged -- who had trained themselves to use handguns and wore ankle holsters. Some of us, myself included, brought large dogs on some calls.
Patients loved this system. Instead of sitting in an emergency room for hours, they usually received prompt attention at a lower cost. We'd arrive to a complaint of chest pain or a child with a fever, do a thorough examination and dispense -- or inject -- medication on the spot. I often hauled a 50-pound EKG machine up three flights of stairs (we charged an extra $5 for that test.) Anxiety attacks were another common problem. I'd get a call from someone saying her husband was having a heart attack. "Where is he now?" I'd ask. "He's outside getting some air," she would respond. Heart attack patients can't do that, so I knew there was no emergency. But when I got there, I sometimes dispensed a sedative.
In many of these neighborhoods, the health impacts of poverty would bring us to the home. I removed roaches from children's ears with forceps and treated a lot of rat bites, often suffered by infants. To keep rats out of their children's cribs, parents would place each leg of the crib in a bucket of water. A rat trying climb the crib leg would fall in and drown.
And sometimes I'd be called to a true emergency, like the patient with one red eye who was suffering an acute glaucoma attack and could have lost sight in that eye without immediate treatment at a hospital. Or the young man with a bubble in his lung for no apparent reason -- known as a spontaneous pneumothorax -- who also needed to go to an emergency room right away.
Payment was sometimes a difficult matter. It was not unusual for people to tell us after we had seen them that they had no money in the house. Small claims court was of little help at 4 a.m., so we told them to wake their friendliest neighbor and borrow it.
The system began to decline when hospitals were forced to pay medical residents a living wage, and the pressure to earn some extra money eased. Advances in medical technology at hospitals and physicians' offices made it more practical to bring patients to the facility; we couldn't carry all that equipment in our cars. And at the beginning of the HIV epidemic, when no one knew what was going on, doctors became reluctant to examine patients without the safeguards of a hospital setting.