The number of doctors visiting patients’ homes is declining steadily. And this is hitting the elderly and terminally ill more than anyone else

Dr Ramesh Sahai hasn’t made a house call in the past 20 years. "Frankly, I don’t have the time for it," says the 55–year–old pediatrician who attributes the long hours spent in commuting as the primary reason for his decision. And he’s not the only one.

Although queues at hospitals and doctors’ clinics have been getting longer, many doctors, especially those in bigger cities, are not interested in making home visits. "I can see double the number of patients in the time it takes to go and come back from a patient’s home. Unless it is a real emergency, I don’t make house calls. Also, I find it very difficult to examine a patient with his entire family hovering around," says a Delhi–based physician.

The reasons may vary, but estimates are that doctors making home visits are getting fewer. Dr V K Narang of the Indian Medical Association says that this is a trend more common in metros. "Long commuting times and increased workloads are the main factors. Also, since home visits are usually emergency cases, it is not feasible for a doctor to go there alone without proper life–saving drugs, which are usually available in an ambulance. In fact, there have been cases where doctors have been assaulted because a patient’s condition had worsened by the time they had arrived."

Even though house calls may have dipped, the demand for home medical care is increasing. According to a report by consultancy firm KPMG, the home health care market in India is estimated to be around $ 1.5 billion. This includes medical devices as well as services like home visits. The country’s elderly population that usually needs home–based medical services is about 100 million currently and growing at about 8%. Many patients and their family members say they wouldn’t mind paying a little extra if more options existed for friendly doctors and reliable nursing staff, who were easily available for house calls.

Delhi–based Sanjeev Mehta, whose 85–year old mother is bedridden with multiple problems, says that it is a real challenge getting doctors to visit her at home. "It is not possible for my mother to go to the hospital regularly and it is not easy for a doctor to visit her unless she develops some complications. It would have been such a blessing if there was a service that provided for patients like her."

And that is happening slowly. "There is a significant unmet need for home visit services in India," says Dr Santanu Chattopadhyay, founder and MD of Nationwide, a Bangalore–based healthcare service that has put together a team of family physicians who are available for consultations at designated clinics as well as for home visits.

Dr (Major) Satish S Jeevannavar, a senior doctor at Nationwide, says they get requests for 30–40 home visits per month. "There are various categories of patients for whom home visits are beneficial and whose needs we are trying to address. Prominent among these are the elderly, many of whom have lost hope in the medical system and who don’t want to go to hospitals where they feel they will be prescribed unnecessary tests. They actually need a friend who can empathize with them and this need is met by our family doctors who visit them. Then, there are the terminally ill and the disabled who cannot visit a doctor and for whom house calls are essential."

Many of those who are offering home visits say there is hardly any money to be made out of this service presently. But they are providing it because it helps bring back patient trust in medical care. "In a city like Mumbai, it’s almost impossible to get a doctor who will have the time to come and visit you at home", says Kaushik Sen, CEO of Healthspring, a Mumbai–based chain of community medical centres that is oriented towards family medicine. "However, we wanted to provide this service since it helps patients trust their doctors more, which is the basic objective of our medical centres. In the future though, there would be a much greater need for this service. This is especially so in chronic cases and for degenerative diseases, whose incidence in India is increasing."

DOCTOR KNOW: Fewer medicos will be making such visits in future