Wednesday, August 7, 2013

Obamacare A Final Epitaph For House Calls?

Not long before my seventh birthday, I was preparing to enter second grade. I was excited about my library books and reading. Then I woke up with a rash.

It wasn't just a rash, though. It was a blazing case of chicken pox. My summer was ruined. No playing wiffle-ball with my friends. No going outside and cooling down in either the kiddie pool in the back yard or at the park district pool. No riding my bike. The only saving grace was that I could sit in the house and read.

Sitting in the house reading wasn't the most comfortable endeavor either. First of all, it was hot. The only air conditioning unit we had was a window unit in my parents' bedroom. Since I had the pox, I wasn't going to be sleeping in there. So, I was itchy and sweaty.

Across the street lived Dr. Thadeus File. He was a family practitioner, a neighbor, and a friend. The morning I came down with the "rash", my father flagged him down as both were getting into their cars. Doc File grabbed his bag and headed over.

He took my temperature. He prodded me a bit. He looked at the rash. He checked my glands and my throat. He looked at my eyes and ears. He made some jokes. He gave me a shot. He scribbled on a pad. He handed my mother the prescription.

Next he told my mother to get an oatmeal and Epsom salt mixture for baths. Calamine lotion was also highly suggested. He told my mother not to vigorously dry me off, but to pat, lightly. He advised against any harsh chemicals or soaps.

Children's aspirin (we still used that in those days) every 4 hours staggered with half a Tylenol (dissolved in fruit juice) were also suggested.

It was an excruciating two weeks that felt more like the entire summer. Though I still had a few scabs, I was no longer contagious and no longer quarantined come my birthday. Doc File stopped by several times to check on me, usually in evenings when he came home from his office.

This was not an isolated incident. Whenever one of us was sick, Doc File would swing by. He'd come on his lunch breaks. He'd stop in after work. He'd come by on weekends. He was our family doctor. He was also our neighbor and friend.

My father was Doc's insurance agent. My father also did the photography for his daughter's wedding. We attended Doc's first wife's funeral as well as his second marriage.

When Doc File did some of his yard work, I would go across the street and give him a hand, sometimes. It was only fair, since I had a bad habit of cutting through his yard on the way to school. He didn't mind that, since I was good about sticking to the walkways. I walked his dog when his first wife was sick.

We weren't the only family in the neighborhood that used his services, either. In fact, Doc File remained our doctor until after my father remarried. We were put into my step-mother's plan, an HMO. I rarely saw the same doctor more than once at that HMO. None of them stopped by to check on me, either. In fact, none of them lent me books to read while recovering, either.

Recently, a doctor moved in next door to my family. I met him, his wife, and his two young kids. Given this neighborhood, he is far from wealthy. In fact, he is just starting his residency cycle as an Air Force doctor. Though he and his family will, undoubtedly, be good neighbors, I doubt he'll be making any house calls. Yes, we are on an insurance plan that would allow him to be one of our physicians.

Most health care plans, these days, are not all that customer oriented. They are impersonal and handle the medical business as though it is an assembly line. It is meant to be more efficient. However, the personal touch is largely lost. These days, the doctors who exude some level of "bedside manner" are highly sought by customers/patients but chided by medical conglomerates. Those conglomerates are the invention of insurance companies to begin with, starting with that HMO model. (Also, they highly discourage house calls.)

Still, you can find those "dying breed" family doctors. Our pediatrician does magic tricks, asks my kid about school, jokes with her, and even suggests books she may like. She's drawn pictures on the paper table covering and given them to him. He says he saves them in his office. Whether he does or doesn't, he remembers the pictures and makes her feel special.

As we face the full implementation of the PPACA, house calls may be fully dead and incapable of resurrection. Patients will be subjected, by law, to the whims and impersonal cookie-cutter healthcare of the HMOs. We'll be forced to have a plan. If the plan is too good (and includes house calls) we'll be fined for having "too good of a plan". If we have a regular family doctor, we'll be forced to find some clinic that takes our plan. Our plans will have to change because rates are increasing, because of the PPACA. Our taxes are going up, as are medical costs. An infuser for a kid's "breathing treatments" will cost more due to excise taxes.

Along with all of this, medical professionals will be forced to document every second of every visit. All of this will have to be put into databases that are shared in some network of medical files. Your medical history will no longer be your private business, but public knowledge. In addition, doctors won't be allowed to do house calls. Sure, they could upload any treatment through a tablet or laptop (or smartphone). However, they will need some administrative bureaucrat to approve any treatment, medication, prescription, or advice. They wouldn't be on-hand during a house call. Even pro bono will have to be documented and reported.

Say farewell to the Hippocratic Oath. Kiss house calls goodbye. The family doctor is now former fad relegated to history. Actually caring and acting human will be considered "unprofessional" and "unethical". This is the decline of civilization.