House Calls?

[DebSumm]

I have just taken a job where my main responsibilities will be house calls and nursing home visits in a Geriatrics practice. As a new grad, I would appreciate advice on what to take. Obviously, the patient's chart, stethoscope, BP cuff, diagnostic kit; and I'm thinking some culture swabs, tongue depressors, Q-tips, measuring tape, tuning forks, alcohol swabs, PDA, Spanish/English medical phrase book, gloves and hand sanitizer, Mace/dog repellent (I'm going into some pretty rough neighborhoods in Philadelphia), and a male medical student. Seems I saw a list on another thread, but I can't find it right now.

 

I know I'm going to love this job. It's got most of what I was looking for in a medical career.

[scut-monkey]

Seems I saw a list on another thread, but I can't find it right now.

 

I know I'm going to love this job. It's got most of what I was looking for in a medical career.

 

Is this what you were looking for? It is from an article that Contrarian had posted...Article about house calls

 

Keep up with the enthusiasm, it is refreshing to see someone who isn't on the verge of burn out!!

[DebSumm]

Thank you. That's a great article. But I thought I saw a thread on here somewhere, where someone had listed all the things he/she packs into his/her "black bag." I'm not worried about it. Maybe I'll find it again someday. If not, no biggie.

[caldje]

Thank you. That's a great article. But I thought I saw a thread on here somewhere, where someone had listed all the things he/she packs into his/her "black bag." I'm not worried about it. Maybe I'll find it again someday. If not, no biggie.

 

Start a new thread. The experienced folks on here were the ones who came up with that list. Many of whom still post here often. Just start a new thread asking and you'll find out what you need. Just label it "what should I bring to house calls?" that way it'll be easier to search if anyone else has a question like yours. It'll likely be helpful to a lot of people.

 

thanks,

chris

[DebSumm]

Actually, I think this is the perfect place to keep it. I've been doing this for a while now, so I'll just list what I've been taking and see if anyone has anything to add:

Temp-a-dots

Gloves

Hand sanitizer

BP cuff

Stethoscope

Diagnostic kit

Patient charts

Extra progress note forms

Pens

Penlight

Tongue depressors

Dressing changes, alcohol swabs, little individual packs of triple antibiotic ointment

Prescription pad

PDA if you're e-prescribing, using reference programs or EMR

Tuning forks and hammer

Pocket eye chart

Cell phone

A nice, plastic pencil-box type thingy that is perfect for taking flu shots or whatever with me. There's a space for a dry ice pack to keep it cold in the car, separate compartments for syringes, alcohol swabs and band aids. Neat!

 

Okay, what would you add?

[cdavis1409]

Thanks all for the excellent info. Another PA and I have been interested in "outside the office" practices and this is a tremendous resource. One thing I might add to the black bag is a small 02 sat monitor. A small resource that I wish I had a some family/friend calls.

 

cd

[DebSumm]

Yes, since my last post, that issue has come up and I did get one. In fact, I had a patient with hypoxia and needed to be able to document his O2 sat in order to get him home oxygen supplies.

 

I also neglected to mention a diagnostic kit. I like the little pocket-size ones to keep the weight down.

 

I've also been campaigning for a Garmin or Tom Tom. I go into some rough Philly neighborhoods and the last thing I need is to get lost.

 

Keep 'em coming!

[cdavis1409]

Another small item that would be helpful would be urine dip sticks. Lightweight, portable, and billable. Also, was a glucometer mentioned?

 

cd

[DebSumm]

To those of you doing this . . .

 

How much did your car insurance increase when you started using your vehicle for work?

[Contrarian]

The "housecall" practice model is steadily gaining traction (just like the retail clinics have). Let's not "miss the boat" on this also...:rolleyes:

 

 

 

New Orleans' Health Care Is Ailing

Two Years After Katrina, Lack Of Adequate Medical Care Is A Growing Problem

 

 

NEW ORLEANS, Aug. 30, 3007

 

(CBS) In her six years as a nurse practitioner, Scharmaine Lawson has been on medical missions to Puerto Rico and the Dominican Republic. But she had no idea she'd be doing Third World work in her own hometown.

 

"Homes that I've passed by all my life, that are gone. No Walgreens, CVS, grocery store, hospitals ... gone," she says.

 

Lawson's practice consists solely of house calls, or, in most cases, calls to the FEMA trailer parked outside the house. She had 100 patients before Katrina; now she has 500.

 

One of them is Alice Pierre, 67, who suffers from heart disease, back problems and diabetes.

 

"My sugar this morning was … oh my goodness. I have CRS now - Can't Remember Stuff," Pierre says with a laugh.

 

Almost all of the patients are elderly and in some cases, bedridden. Those who can manage to get to a doctor often can't find one.

 

How would Lawson describe the state of health care in New Orleans? "It's still on the respirator," she says. "It's still in the ICU."

 

Two years after Katrina, the health care system in New Orleans is as dilapidated as many of the still-unlivable houses, reports CBS Evening News anchor and managing editor Katie Couric. Four hospitals remain closed, thousands of doctors have left, and a quarter of the adult population has no insurance.

 

"The hospitals in this area are literally hemorrhaging cash, hemorrhaging resources," says Dr. Kevin Jordan, chief medical officer at one of the few remaining hospitals. He says emergency rooms are even more overtaxed today because of the exodus of primary care physicians.

 

"You can wait anywhere from a month to a month and a half, two months to get a regular appointment, given that that doctor is willing to see you. Because remember, there's that much demand," he gestures with spreading arms, "and that much resource," he adds, closing the gap with his hands.

 

Only three months ago, the federal government finally agreed to pay $100 million to fund primary care clinics in New Orleans. But earlier this month, Mayor Ray Nagin went to Capitol Hill and said, "Show me the money."

 

"I keep hearing about this $100 million that's been allocated to the Gulf Coast, but I have seen very little of that money in the city of New Orleans," he said.

 

Until it arrives, there are people like Lawson, who's not just a nurse. In fact, in her current role, she's a social worker, financial adviser, and even a detective. So many medical records were lost or destroyed that she's had to piece together countless patient histories.

 

"A lot of patients I went out to see didn't have any records, didn't have anything," she said.

 

And because mental health services are woefully inadequate, some say non-existent, she is a part-time therapist as well.

 

"You have had some pretty tough problems with depression, haven't you?" Couric asks Pierre.

 

"A lot of things came through my mind. But I had to ask God to forgive me because I just didn't want to be here anymore," she cried.

 

Why does Lawson do this?

 

"I'm from here," she says. "And my grandmother who raised me, when she got ill, it was very difficult for her to get out and see a doctor or anyone to help her. So whenever I see little old ladies like Miss Alice, I feel like I'm doing it for her."

 

 

See video here

 

© MMVII, CBS Interactive Inc. All Rights Reserved.

[DebSumm]

Update: Okay, I've been doing this for over a year now, and it is the ONLY thing I do. I'm in a practice with 2 docs and 2 PAs. We gather in the office in the morning to confer with each other, answer phone calls, review labs, etc. The support staff makes and confirms the appointments, gives us the charts and any special requests from the patients, and out we go. We have a program on our computer where we input the office address, our home address, and all the stops along the way, and it charts the best route. I did buy a Garmin Nuvi, and it was the BEST investment I ever made. It has saved me on average an hour a day (mostly from getting lost and making u-turns). I set it to a British English male voice I call Nigel, and he keeps me company on the road. I see on average 6 patients a day (what a luxury!) and love every minute of it. (Okay, maybe not so much the day last week when a policeman was shot in the head and killed, and all my calls were in that neighborhood, but usually).

 

If anyone wants encouragement to enter this field, send me a PM. I'd be happy to share my experiences. There are soooo many patiens who cannot get our of their homes and are doing without medical care. There is such a big need there.

[FriendlyPA]

I've been thinking about opening up a housecall practice for a long time. Can someone tell me how easy or hard is it for a PA to do this??? The real question is, do I have to contract with insurance companies or can I do it on pay per service bases in a big city (which is my prefered way).

[Guest mjazayeri]

Hi Everyone,

Are house calls still being done? I am starting a house call ONLY business. What are the best target areas for patients..ie SNF, Asst Living, 55+Communities ect. What are some of the problems that have been experienced? Do you bill under your supervising MD or yourself for reimb?

thanks,

MJ

[kidnid]

Where i live i.e IL .....I have come across so many House call jobs!!..... The company provides car, medical assistant and supplies. The pay starts at 100k :))

More can be billed if you make calls to patients house rather than SNF--- usually elderly, home-bound, who dont have car access, rural/urban areas included.