House Calls with John
A retired member of the Dartmouth faculty reflects on his varied career—and makes the case for the powerful healing effects of the house call.
I learned the value of making house calls early in my career and even in retirement continued to make home visits as a volunteer caregiver. The hustle and bustle of the usual medical practice allows the doctor to acquire only a superficial knowledge of the patient as a person. Sometimes the individual behind the clinical history—not to mention the patient's family and living situation—is central to the success of treatment. In addition, I have learned much from my patients, especially when I get a chance to see them in less structured settings. They have taught me the importance of taking time to listen, of digging for real answers, of regarding everyone with respect.
My interest in medicine arose during high school when I found part-time work as a hospital orderly. After service in the infantry during World War II, I entered Bates College on the GI Bill and—thanks to summer studies at Bowdoin and the University of New Hampshire—graduated in two and a half years. Then it was on to Harvard Medical School, a rotating internship at Mary Hitchcock Memorial Hospital, and a pediatrics residency at Massachusetts General Hospital.
There, I came under the influence of Dr. Frederic Blodgett, who made regular house calls in the west end of Boston, an area filled with tenement housing. He knew the neighborhood well. As he walked the streets, former patients would call down from their apartments, "Hello, Dr. Blodgett," and he'd call back to them by name. I clearly remember one of the first times I accompanied him, to see a sick child in a fourth-floor flat. The building was in poor condition outside, but inside the apartment was immaculate. As he listened to the mother describe the illness and then examined the child, he placed them both at ease by explaining exactly what he was doing. He obtained a throat culture from the patient, who had tonsillitis, and left some medicine, assuring the mother that he would return in two days to check on her child's progress. I immediately realized the importance of such visits, especially for families without transportation or with few resources. I also appreciated the dignity with which Dr. Blodgett approached patients, as well as their confidence in his caring manner.
By the time I finished my training I was married, and my wife, Dotty, and I had three small children—so I needed to open a practice quickly. We settled on Bangor, Maine, and bought a small house; as was the fashion then, I planned to open a home office. I even created a clinical laboratory in a former pantry next to the examining room. I was able to perform blood counts and throat cultures, which I incubated in a cardboard box heated with a 15-watt light bulb (I tested different-sized bulbs and determined that 15 watts was perfect to maintain a 98.6-degree temperature). I hung my shingle in August of 1955 and awaited patients. My first visitor was a woman who brought her ailing dog. This was not an auspicious start!
After a week of no (human) patients, no income, and mounting bills, we were getting deperate for some income. It was potato-picking season in Aroostook County, l00 miles to the north, so I rented a small room there and picked potatoes for four days. Finally a phone call to Dotty revealed that someone had made an appointment. I returned home eagerly and stepped into the waiting room to greet my first patient—only to find that our new puppy had left a calling card in the middle of the waiting room. Embarrassed, I cleaned the rug before inviting the mother and child in for an interview and examination.
Other patients followed, though slowly at first. Soon, however, the visiting nurses alerted me to a number of families living
in poverty whose children needed care. I would often tell such parents, when I needed to follow up on a child with an ear infection, for example, that I would be making house calls in their neighborhood. "Why don't I stop at your home to check that ear without any extra cost to you," I'd say to them. They were always grateful.
One of my early house calls was to a family whose address appeared to be in the middle of a field. Puzzled, I asked for help from a neighbor at one end of the field. "Yes," was the response, "there is a family living in the field—in that little hill is a potato house with a little door at the end." The structure was partly below ground and had no windows. Needless to say, I did not charge for the house call and levied very modest fees for future office visits.
But the patients were not the only ones having financial difficulties. I did not send any bills for the first six months, in the belief that the schedule of charges posted in the office would be adequate notice. This did not prove profitable. When I began to send bills, our financial status improved, though not appreciably. At the end of my first year of practice, my annual income was minus $50.
But things improved. I got to know the three other pediatricians in Bangor; we asked each other for advice and shared night and weekend call. Soon I was quite busy and began seeing patients with more complicated problems that taxed my abilities. While I was covering for one of the other pediatricians, I made a house call on a child with a draining ear. He was already on an antibiotic and exhibited a fever and a stiff neck. Suspecting meningitis, I immediately admitted him to the hospital. A spinal tap, however, showed no organisms in the spinal fluid or the ear drainage. I had to guess, lacking any information to the contrary, that he was suffering from the most common cause of meningitis in his age group and treat him with the appropriate antibiotics. Cultures the next morning still showed no organisms, but because the child was worse I arranged to have him flown to Boston. Two days later, he died of tuberculous meningitis, which can only be diagnosed with special bacterial stains for tuberculosis. It was not a possibility I had even suspected.
John Radebaugh, a retired pediatrician and family physician, is a clinical associate professor emeritus at Dartmouth Medical School. He also did a rotating internship at Mary Hitchcock Memorial Hospital. All the photos in the article are courtesy of the author.