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The modern-day black bag still contains a stethoscope but also a cell phone and a personal digital assistant like a Palm or laptop with detailed patient histories. Moreover, "most point-of-service diagnostic equipment has become so portable that house-call physicians have the capability of providing care comparable to an urgent-care center in the home," says Dr. George Taler, co-director of the Washington Hospital Center Medical House Call Program in Washington. "Even intravenous therapies, medications and oxygen are readily available at the time of the visit if the physician wishes to offer advanced care for those patients who would prefer to avoid the emergency room or, for that matter, the hospital. It may seem counterintuitive, but many physicians who make house calls an important part of their practice are far more technologically equipped than most of their colleagues who confine their practice to the office. It makes the office seem devoid of information."
Lyons, Irene Kurzweil's physician, started doing house calls six years ago. "This is the only thing that I found really satisfies my desire to be a doctor," he says. "I am involved in my patients' lives and get to know them as people." His black bag includes a Palm computer that has wi-fi for e-mail, a special database for patient histories and lab results, and a customized word-processing program. He also carries a battery-powered electrocardiogram (ECG) machine and portable lab kits to do finger sticks that test blood-glucose levels. The doctors often work with lab services that send out technicians to draw blood and with medical companies that provide portable X-ray machines, scanners and ultrasound devices.
While colleagues in an office-based practice see about 25 patients daily, house callers see just six to eight. "But once you've made one or two house calls, the power of the setting is very clear," says Taler. Dr. Thomas Cornwell of HomeCare Physicians in Wheaton, Ill., has made 19,500 house calls since he started in 1993. While he notes that "we do all our own blood draws because we do not have a service in the area that does blood drawing," he believes that he can do a better physical of his patients at home. "I can't give them a good exam at the office because they can't get out of the wheelchair," he says. "At home in bed, you can examine the whole body." He can also snoop around the house. "We open a lot of refrigerators and look at bathrooms," he says. "You find patients are taking their medications wrong. You try to prevent crises, and nothing can do that better than seeing people in their own environment."
Advocates of house-call medicine say it also saves money. In July 2005 the Centers for Medicare and Medicaid Services awarded California's Care Level Management funding for a three-year demonstration project to provide house-call care to 15,000 Medicare recipients in California, Texas and Florida. This month an additional 13,600 beneficiaries are being given the chance to participate in the program. "If you provide that very intense level of physician service, you can potentially eliminate some very costly hospitalizations or trips to the emergency room," says Jeff Flick, a regional administrator for Medicare services based in San Francisco.