By himanshu sharma, MD
As a family physician who specializes in geriatrics, one of the most valuable services that I offer is the home visit. This provides more information than a clinic visit as a home visit allows the physician to gain a better understanding of what affects patients’ health and what is most important to those individuals. To illustrate the power of a home visit, I want to tell you about a patient whom I will call “NH,” a 98-year-old gentleman that came with his next-door neighbor to see me in the clinic.
He looked at me and said, “Doc, I was working in my backyard on my car. Pardon me for my dirty hands.” During our discussions, I learned he was a World War I veteran who lives by himself, having never married. He had one sister, but she lived in California in Stockton and he had not talked to her in 15 years as he did not have her phone number. I called directory assistance and was able to get her phone number. We called her and and put the siblings in touch. They talked for forty-five minutes. When NH was done, he mentioned that he had not been this happy for decades. He now after such a long time found her baby sister and they had set up a time to talk to each other.
At this time, I felt that I had a good understanding of NH. He was socially isolated but eager to reconnect with family. We already made progress at that by reconnecting him with his family. Oftentimes the full understanding of a patient stops here, but I decided to complete a home visit and this helped me better understand him so much more.
At his next appointment, we decided to complete a house call and I went to his place with my colleague. I was surprised to find that this 98-year-old veteran lived in a thinly insulated home in St. Paul—what some might call a “shack”— with an outhouse toilet. A dim light bulb in his room was the only light source. He accepted some cooking help and other home care help and had a social worker. Although it was not much, I learned that he was quite content at his place. He liked his home and loved his routine of reading the daily newspaper there, sipping coffee and working on his old car. He wanted to continue to living at his home for as long as possible. Now I had a better understanding of what was needed to help him with that goal.
In mid-December, his social worker called me concerned about NH in the cold, as his heat was not working. The outside temperature was subzero as it was a typical Minnesota winter. From our home visit, I knew that this was not safe for him. He came into the hospital and then later went to a transitional care unit. Our goal was to get him to his home as soon as he got his heating back. He missed it very much. When I went to see him at the transition care unit, he said, “Doc, I think God is calling me to His sweet home, as I cannot go to my sweet home soon enough.” The next morning, I got a call from nursing staff that he had passed away in his sleep. He had a veterans’ funeral. When the county checked his place, it was found that he had saved 500,000 dollars, which he gave to a particular charity that he had attended regularly.
This experience with NH reenforced how a home visit helps me provide better, more comprehensive and compassionate care for my patients. In a clinic visit, we just see a person for only a little bit of time and do not get a chance to truly know them. We often see only a small portion of person’s life, like the proverbial tip of the iceberg, whose fathomless depths float beneath the surface. Patients are also not usually themselves in the clinic, often not as comfortable as they would be in their homes. Home visits help physicians better understand what a patient needs to help them stay in their “sweet home” for as long as possible. I have been completing home visits with my patients for three decades and look forward to many more in the future.
To schedule an appointment to see Dr. Sharma, call 651-241-5200.
By himanshu sharma, MD