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PEDIATRIC RESIDENTS LEARN PATIENTS' REALITIES THROUGH HOME VISITS PROGRAM

In the managed care era, the concept of house-calls never sounded more passe. But University of Virginia pediatric residents are making house-calls as part of their curriculum -- and learning some vital information about patients in the process.

Dr. Leigh Grossman Donowitz, professor of pediatric infectious disease, created the U.Va. Pediatric Department's Home Visit Program in 1995. Next Monday, October 25, Donowitz is presenting the story of the program's success to deans and teachers from medical schools nationwide at the Association of American Medical Colleges annual meeting in Washington, D.C.

Donowitz has successfully extended the program to Columbia Presbyterian Hospital in New York, which serves patients in Spanish Harlem, and the Robert Wood Johnson Medical School in New Brunswick, N.J. My goal is to make this program a possible part of the residency curricula at medical schools nationwide, she said.

House-calls have all but disappeared in our medical culture because they are not an efficient way to deliver care, said Donowitz. During an office or hospital visit, we delete the bigger story of a patient's life and focus on the illness. However, during a house-call, we might discover that a sick child sleeps with four other children in one bed. Or we might see a hazard like a patient's home oxygen tank placed next to an open kerosene heater, or an asthma patient living in a condemned building with no heat.

As a graduate student in public health and medical student, Donowitz said, she visited hundreds of homes to provide community-based care. She said that much of what physicians ask families and individuals to do in the home today far exceeds families' resources and capabilities. For that reason, students and residents need to have a basis for understanding very different home environments from what they might be used to, and the Home Visit Program aims to create that understanding, she said.

The Home Visit Program has received $10,000 per year since 1996 from The Arthur P. Gold Foundation, which fosters humanism in medical students. Every month, Donowitz and a group of five or six pediatric residents pack a blue van with standard medical supplies and equipment and travel to patients in Charlottesville and surrounding counties. The foundation funds cover supplies, staff time, and the cost of the van. The residents visit their own practice patients. The pediatric curriculum now requires them to make at least two home visits a year to patients.

Dr. Taylor Troischt, one of this year's resident directors of the program, said, This educational program covers components we are expected to know in the daily care of patients, but which we would otherwise struggle to find out. The knowledge we acquire in just one home visit leads to a new level of understanding, allowing us to truly individualize our care plans and make them practical for each patient.

October 19, 1999