House Calls and Humor: What I Never Scheduled to Find as a Solo Doctor
A patient said something to me after a recent house call that stuck with me. They admitted that before my first visit to their home, they were not sure how they felt about having their doctor see them there. It just seemed unusual.
That surprised me because I had been their physician for quite some time. But they gave it a chance because they already knew me. Afterward, they told me the home visits had saved them considerable time and, in their experience, had led to better care.
That got me wondering: when did it become strange for a doctor to come to a patient's home?
Being the nerd that I am, I looked it up. Naturally, what started as a simple question turned into a minor historical investigation.
I found a fascinating article in the Annals of Internal Medicine tracing how outpatient medicine in the United States changed from highly individualized interactions to standardized appointment schedules. It helps explain not only why house calls faded, but also how something as ordinary as a calendar became such a powerful force in modern medicine.
In the late 19th century, physicians commonly traveled to their patients. That might mean walking, riding horseback, or traveling by carriage. The doctor brought whatever diagnostic and treatment tools were available and often spent substantial time caring for patients in their homes. It was personal, practical, and probably excellent exercise for the physician.
It was also terribly inefficient. A large portion of the doctor's day could disappear into travel, which is not ideal when several other people are waiting for you to arrive with your medical bag and your horse.
As cities grew around the turn of the 20th century, medicine began to change. Telephones made doctors easier to reach. Automobiles made offices easier to get to. Diagnostic and therapeutic technology became more sophisticated, but much of it was difficult to carry from house to house. At the same time, physicians were being asked to do more, including preventive care and the treatment of illnesses and workplace injuries associated with industrialization. Medicine gradually became more centered around the physician's office.
By the 1920s, many physicians were busy enough to hire assistants or secretaries to help manage their practices. One of their most important jobs was managing the doctor's time. During World War II, physician shortages added even more pressure for efficiency. A common approach was the "office hours" model: the doctor announced when they were available, and patients simply showed up and waited their turn.
You can probably imagine how that went.
Waiting rooms filled, doctors fell behind, and patients had no idea whether they would be seen in ten minutes or sometime before retirement. The appointment system emerged, at least in part, as a solution.
Now patients could schedule ahead, and offices could organize the day around the physician's pace, the type of visit, and the resources required. Medicine had discovered the calendar.
What surprised me most was how much thought once went into using it. A medical secretary's job was not simply to fill the next empty box. Scheduling could be individualized according to the patient's needs, how quickly or slowly a physician worked, and what the office needed for the visit. Keeping the day moving mattered, but the larger goal was to protect the doctor-patient relationship.
For a solo physician serving a community, that relationship was the foundation of the practice. Patients returned because they trusted their doctor. The physician knew the patient, often knew the family, and sometimes knew the home they lived in. The schedule existed to support that relationship.
Then the economics of medicine changed. Health insurance expanded, practices grew larger, and administrative work became more complicated. Physicians increasingly worked in larger organizations that could share staff, technology, office space, and other resources. There were real advantages to this. It is, after all, much easier to run a CT scanner when you are not also trying to fit it into the trunk of your car.
But standardization came with a tradeoff.
As practices grew, scheduling increasingly had to serve the needs of the organization rather than one physician and one patient. Centralized call centers could handle large numbers of requests, and uniform appointment lengths were easier to manage, staff, and scale.
What was efficient for the organization was not always ideal for the patient or physician. One patient may need five minutes; another may need thirty. The physician might know that, but the calendar may already have made the decision.
The appointment, originally created to make care more predictable and personal, slowly became something closer to a unit of production.
And that brings me back to the house call.
Maybe the lesson is not that we should return to a time when doctors traveled everywhere by horseback with a medical bag. I am personally quite happy with heated seats and GPS. The lesson is that medicine once understood something we may have standardized away: the schedule should serve the relationship, not the other way around.
That is one of the things I value about practicing concierge medicine now. Sometimes the best place to care for a patient is an office. Sometimes it is a phone call. And sometimes it is their living room. The important part is having enough flexibility to choose what makes sense for the patient in front of you rather than forcing every medical problem into the same little square on a calendar.
After more than a century of innovation in medical scheduling, one of the newest things I have discovered as a solo doctor is something physicians knew a very long time ago: sometimes the easiest way to take care of a patient is simply to go where the patient is.
Reference: Nguyen MLT, Schotland SV, Howell JD. From Individualized Interactions to Standardized Schedules: A History of Time Organization in U.S. Outpatient Medicine. Annals of Internal Medicine. 2022;175(10):1468-1474. doi:10.7326/M22-1575
Dr. Sharma is a board-certified family medicine physician and the founder of HealthWinds, a virtual-first family medicine practice serving DuPage County and the surrounding Chicago suburbs. He brings over 15 years of family medicine experience with Duly Health and Care and Loyola Medicine's MacNeal Hospital, among others. He sees patients ages five and up, with longer visits and direct access built around a membership model rather than insurance.
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