Day One: The House call

You know you were looking for these dance moves online :)

Yes, you read right, I went on a house call with Dr. Byrant today. How many of your thought that “house calls” went out with the funky chicken dance and bell-bottom jeans, or do you still do the funky chicken in your bell bottom jeans when no one is looking?

Although not common anymore with the emergence of hospitals in closer proximity to residencies, house calls are a rare but still alive part of the family practice physician’s job.

Dr. Bryant’s house call visit involved an elderly woman who said she was taking her medication daily but 1) based on pharmacy records had only refilled 4 times in 2010, when the medication required a monthly refill and 2) her thyroid readings continued to be very inconsistent with one month reading below average, then the next month way above average. Dr. Bryant’s goal was to go over to her house and figure out whether the patient had all of her medication (which in all honesty was a lot, 6 different medications she has to take a day) as well as if she was taking her medication correctly. What we found was a completely unexpected.

The patient did have all of her needed medication; in fact she had a surplus of medication. One medication that she was half-filled and recorded on the label to have been filled in early October, however, she had another half-filled bottle of the same medication that was filled in December. This was a definite sign that  either the patient was not taking her medication every day like she was suppose to, or she was taking her medication from two different bottles unknowingly which is why they weren’t empty. Honestly, I think it was a little of both since her pharmacy records would have shown her having 6 refills instead of 4 refills if she was taking the medication from two different bottle.

This visit made me aware of the conflicting feelings a doctor may encounter when trying to do their job. Dr. Bryant obviously cared about her patient to go above and beyond the call of her job duties by taking the time to visit her patient at her home. At the same time, the fustration of the patient's choice to not follow her directions for the patient's own good was also very evident. Although I knew this was part of the job, actually seeing this in Dr. Bryant was eyeopening. What added to the fustration was that we left the house with more questions that answers.

--Why is her husband giving her refills on medication even though she is not done with her current one?

--Why are the refills infrequent and irregular?

--Why is it so hard for the patient to be compliant with the instructions given to her by Dr. Byrant, although it is evident by the patient’s actions that she likes Dr. Byrant and has no problems with her?

--Most importantly, what to do next to help the patient?

This experience reminded me that Doctors are in essencse, medical advisors and not miracle workers. Doctors can only advise and to the best of their training help patients better their health, however the patients in the end are responsible for making possiblity of better health a reality. Sometimes I wonder if patients understand this fact completely. As future doctors we will spend the next four years in medical school learning the ins and outs of patients anatomically and in some sense sociologically (that may be a made up word). However, how much will patients know about the doctor's job? Is the misunderstandings of the job of a doctor the fault of current and past doctors or ours? Something to think about.

Anyway, in short, my first house visit was definitely rememberable.