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Monday, September 26, 2016

House Calls: Conveniently using picture hooks

Dr. Thomas Cornwell’s story:
I had a 92-year-old patient with a very high temperature, 104.9 degrees Fahrenheit.  Her daughter said she was lethargic and unwilling to eat or drink.

I made a house call to see her.  There was no obvious source for her temperature. After the technician drew blood to be tested by the I-stat machine, I set her up for a chest X-ray. 
My exam and the blood test results showed her to be dehydrated (BUN 97) and hypokalemic (low potassium of 2.9). While the technician developed the X-ray, I started an IV with normal saline for hydration plus potassium chloride 40 mEq. 
The chest X-ray revealed a right-sided pneumonia so we determined the source of her fever.  She had a terrible experience in the hospital three years earlier, and she and her family refused hospitalization. 

The patient was started on an IV antibiotic (Ceftriaxone) which lasts twenty-four hours along with the hydration IV (conveniently using picture hooks). It is not uncommon for us to care for critically ill elderly or terminal patients in the home who are at a stage where they no longer desire hospitalization. 

The photo shows her surprising recovery by the next morning.  She passed away four years later on hospice, having never spent one night in the hospital. 
Ever since I treated her in 1994, I have been continually amazed at how well people do when treated at home. Over the past 20 years, I have made over 31,000 house calls to more than 4,000 home-limited patients.  Not only is this incredible care, there are huge cost savings.  A study of 11,000 veterans found that house calls saved $9,032 per patient-year in total costs.
Thanks to Dr. Cornwell, Chief Medical Officer of the Home Centered Care Institute and John Wasik of the New York Times for this story.  Read about a very different kind of house call

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