Incorporating home visits into practice

As a part of my clinical practice, I do home visits. I know this is not very common. Usually this is for patients who live in the general area around my hospital and are on hospice, or for older patients who have difficulty coming into the hospital for a variety of reasons.

I find it a very enriching experience for many reasons. Firstly, the patients really appreciate it, as do the families. It is understandably nice not to have to drag your loved one into the clinic when they are on hospice. Secondly, it is useful to do the meetings with the hospice nurse there, which expedites orders, and keeps everyone on the same page. (Is it just me, or do you get about three faxes for every order you give to a home care agency? Holy cow!) Sometimes I make a simple discovery about why my treatments aren’t working ... the patient who kept all her pills in a big bowl and fished around for “the blue one” when she had pain comes to mind. It’s nice just to meet the family cat too. And on the two afternoons a month that I do home visits, I get more cookies and coffee than anyone should really ever eat.

The downsides of the home visits are obvious: the time it takes to get to and from the house, the lack of availability of laboratory and radiology tests, and the relatively low “billability” of home visits — for many providers it is just not an effective use of your time.

I found an article in the Journal of Clinical Oncology that supports the oncologist’s role in doing home visits. But will it translate to “the real world?" I think if you can swing it fiscally, it is worth the effort.