SF Doctors Group Goes Back to the Future
Wouldn't it be great if doctors still made house calls, the way they did in the old days?

Guess, what? Some still do.

For the physicians of San Francisco On Call Medical Group, house calls are a regular part of each workday. Armed with a 21st century doctor's bag containing modern diagnostic equipment and a range of pharmaceuticals, the group's physicians are available around the clock, seven days a week to visit patients in their homes around the Bay Area.

"There is a real demand for the type of quality, unhurried medical care that many doctors provided in the past and that made health care simple," says Dr. Jordan Shlain, the group's medical director. Shlain formed San Francisco On Call Medical Group with Dr. Clifford Sewell in 1997, in response to the doctors' growing frustration with what he describes as "the fast-food approach to medicine that currently exists."

"When you're sick and need urgent medical attention, it's a lot more convenient to have a doctor come to see you than it is for you to drive to an emergency room and spend hours waiting to see a doctor who has very little time to treat you," says Sewell.

"And if you've ever tried to schedule a same-day appointment with your doctor, you know that's almost impossible," adds Sewell. "But the On Call Medical Group can come to your home on short notice and treat most acute and chronic medical problems on the spot. We're a 24-hour mobile emergency team."

Highlighting the hurried nature of most patient-doctor encounters in today's world, a recent study found that American patients now have just 23 seconds, on average, to explain their problems before being interrupted by a doctor, and just 2 percent of patients were able to finish their explanations. The report, which appeared in The Journal of the American Medical Association in 1999, links poor patient-doctor communication to misdiagnoses, the failure of patients to follow treatment plans and other problems.

Callers to the group's office, which is located near San Francisco's Union Square, are connected to a physician, who makes an over-the-phone assessment to determine whether a house call is appropriate. People with life-threatening emergencies are directed to call 911. At least one of the group's four board-certified physicians is present in the office at all times.

Sewell, who treats many of the group's older patients, says house calls are particularly valuable for homebound seniors who otherwise might never be seen by a physician. "I've gone to see older patients who literally couldn't walk around their house because of an illness or injury, let alone travel to a doctor's office," he says.

Treating patients at home also gives the doctors a chance to do a safety evaluation and determine whether the patient might need to change their living situation. "I look at how they get around their home and can address potential trip and fall hazards," says Sewell, who says he doesn't know of any other medical groups in the Bay Area that routinely make house calls. "I can also get a sense of whether they're getting enough nutrition, which is an especially important issue for seniors."

The house call service provided by San Francisco On Call Medical Group "fills a need in the community," says Jeanne Robinson, a San Francisco geriatric care manager and conservator. "I've had clients who were simply unable to go out to a doctor. Either the need was too urgent for their primary care physician to schedule a home visit, or they were too psychologically impaired to go out to a doctor.

"In the first case, a home care doctor may save a life or at least the health of a patient. In the second situation a compassionate caring physician in the home may enable an impaired person to go out to a doctor in the future because their fears were abated by the positive contact at home," Robinson explains.

Although the group's doctors are usually called in emergency situations, they often remain active in the care of patients. "We do not replace their primary physicians. But there are some patients who like us to continue coming to their homes for follow-up service," explains Sewell. "We find that many primary physicians feel relieved to have our assistance."

Should a patient require hospitalization after being examined by one of the group's doctors, San Francisco On Call Medical Group has admitting privileges or direct contact with several of the Bay Area's top hospitals, including California Pacific Medical Center, St. Mary's Medical Center and UCSF/Mt. Zion Medical Center. The group's physicians take an active role in the hospital admissions process, and stay involved in the medical management their patients from admission to discharge.

In addition to residential house calls, San Francisco On Call Medical Group provides house call services to travel industry customers, including the Westin St. Francis Hotel, the Mark Hopkins Hotel, the Clift Hotel and Princess Cruise Lines.

The group recently added two physicians, Eduardo Peña-Dolhun and Yan Chin, and now treats people of all ages, from infants through the elderly.

A fee-for-service practice, San Francisco On Call Medical Group charges $205 for a daytime house call, with additional fees for evenings, weekends and holidays. The group doesn't accept Medicare and insurance carriers view them as out-of-network providers. But Sewell says many patients with private health plans are reimbursed for more than half of the group's fees.

The group provides patients with a one-page bill that can submit to insurance companies. Patients are encouraged to contact their health plan to determine their policy for house calls. All labs and other tests are handled by and covered by insurance plans.

"It may sound like a lot of money," says Chin, a pediatrician. "But you're paying for time and quality. We spend at least 45 minutes to an hour with our patients in their homes, which allows us to really listen to their problems and make a more accurate diagnoses. It's much more compassionate than the five-minute doctor visits people have grown accustomed to."

San Francisco On-Call Medical Group is located at 490 Post Street in San Francisco. For information, call (415) 732-7029 or visit www.sfoncall.com.

(This article originally appeared in the Summer 2004 issue of Bay Area Summit)

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