Thursday, August 30, 2012

Phrases I hear again and again

“Can you come up right away?”

It’s surprising how many guests believe I am sitting in an office downstairs. In fact, I’m at home or going about my daily business when the phone rings. I keep a suit jacket, tie, black bag, and paperwork in the car. Inevitably, calls arrive at awkward times such as during a meal or movie. Meals don’t take long, and I can’t enjoy a movie knowing a patient is waiting, so I leave. Most of the time, I’m happy to go, and when people express sympathy I point out that, unlike other doctors, after I see one patient, I go home.    

“I’ll call you back.”

Before making a housecall, I speak to the guest, ask about his or her problem, and deliver my impression. I may simply give advice because only half my callers require a doctor’s presence. If a housecall is appropriate and the guest agrees, I announce my time of arrival and the fee.

Middle-class Americans are mostly insured. Talking to a doctor willing to make a housecall is already disorienting; hearing they’ll have to hand over money comes as an additional jolt, so they often reconsider (“I’ll talk to my husband and call you back…..”). This is my signal to switch gears and find an alternative means of care: office visit, urgent care clinic, or sometimes even a reduced fee.

“Sorry about the mess”

Entering a room, I look for a place to set down my writing material, so I hear this as someone hastily removes the pile of articles covering the desk. After learning about the illness and perhaps putting a thermometer in the guest’s mouth, I announce that I will wash my hands, so I hear it again as someone rushes ahead to clear a space around the sink. 

“Do you accept insurance?”

My answer is yes – if the guest is foreign and has purchased travel insurance from an agency with an office in the US or that is willing to give a credit card number so I can pay myself. I work with a dozen. It’s no for Americans. US insurers look with suspicion on housecalls, and billing them is a complex process; doctors' offices employ trained billing clerks. I work alone.


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