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Can Fam Physician. 2010 July; 56(7): 724.
PMCID: PMC2922825

Housecalls—rediscovering a lost art

Cal Gutkin, MD CCFP(EM) FCFP, EXECUTIVE DIRECTOR AND CHIEF EXECUTIVE OFFICER
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Dr Mark Nowaczynski is a family physician in Toronto, Ont, a Certificant and Fellow of the College of Family Physicians of Canada, a dedicated clinician and teacher, and an accomplished photographic artist. Until October 11, 2010, the Royal Ontario Museum is featuring 36 of his photographs in an exhibition called “House Calls with my Camera.” If you live in or are visiting Toronto, you should add this to your calendar.

Housecalls have been an important part of the general practice of medicine throughout the history of our profession. Recent years, however, have seen progressive declines in the number of housecalls carried out by physicians.1 There are many reasons for this, mostly related to inadequate remuneration, urban traffic and parking hassles, and time constraints for physicians trying to keep up with the demands created by doctor shortages and an aging population with more complex medical problems. While some diagnostic workups and treatments are best managed in office or hospital settings, those who provide housecalls know that patients, doctors, and the patient-doctor relationship, which is critical to better health outcomes, all benefit from the knowledge that is gained and the bonds that develop during home visits. For patients whose physical, mental, or socioeconomic challenges make it difficult for them to leave their homes, regularly scheduled housecalls might in fact be critical to their survival.

Nowaczynski has committed his practice to caring for elderly, marginalized, and housebound people in inner-city Toronto. He believes in the value of every person’s life and has done something to try to provide medical care for many who would otherwise not receive it. His patients are generally neglected and struggling to survive. What started as part of a broader office-based family practice has become the full-time focus of his work. He now works with a team of nurses, occupational therapists, social workers, and other health care providers. Together they deliver and coordinate all the medical care needs of those they see—they are a mobile patient-centred medical home! Nowaczynski is also often accompanied by medical students or family practice residents, offering them invaluable learning experiences.

Despite the need for and success of Nowaczynski’s work, our system has not yet provided the broader support needed for the provision of housecalls for the housebound, elderly population—and family physicians have not been lining up to provide these services. The result is that those most in need of regular home medical assessments and treatments—the elderly, frail, and disabled—remain without the attention and care they require.

While Nowaczynski has been frustrated with this lack of progress, he has not given up. In fact, he has found other ways to share the message of the value of these services for patients and the rewards and joys that come to those who provide this type of care. His sensitivity and compassion have been expressed not only through his daily practice but also artistically through a series of brilliant black-and-white photographs he has taken during his housecalls. With these photos (always taken with the consent of his patients) and the narrative descriptions accompanying them, he is able to convey what his mind has learned, what his heart has felt, and what he has seen through his own and his camera’s eyes. The stories he shares unfold as reminders of the harsh realities faced by so many of our elderly population clinging to the last vestiges of the lives they once had, feeling forgotten by a society that they once contributed to in so many ways. They also remind us of how much more could and should be offered to so many who are struggling through their final years by those of us with the ability and responsibility to provide them with the health and medical care they need and deserve.

In her editorial column in the Toronto Star, Carol Goar describes the exhibition at the Royal Ontario Museum as “powerful” and “deeply respectful.”2 She hopes it will deliver messages to many, including “young doctors to revive a tradition [of housecalls] that should never have died,” “health-care bureaucrats to acknowledge that the rush to schedule more … procedures … is leaving those who built this country behind,” and the public to be more aware of the “rundown homes where seniors live, fearing institutionalization as much as death.”

“Ask yourself,” she states, “if this could be your grand-parent or parent—or someday you.”

Housecalls, care of the elderly, the role of the family doctor—are these only linked as memories of a distant past or might they be revived and become critical parts of a health care plan for the future? Has Nowaczynski, by combining the skill and compassion of a family physician with his photographic genius, rediscovered a lost art?

Footnotes

Cet article se trouve aussi en français à la page 723.

References

1. Meyer GS, Gibbons RV. House calls: a vanishing practice among physicians. N Engl J Med. 1997;337(25):1815–20. [PubMed]
2. Goar C. Glimpse into a lonely, hidden world. Toronto Star. 2010 May 24;

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada