December 1998 Bulletin

Knock, knock. . .

Orthopaedist makes house calls to help the elderly

By Sandra Lee Breisch

House calls. A thing of the past? Not if you talk to Shanker Krishnamurthy, MD, a general orthopaedist in group practice at the Community Orthopaedics Associates in Peekskill, N.Y.

In 1982, Dr. Krishnamurthy's first house call was to "an elderly guy who lived in the boondocks" who had a hip replacement. "The weather was really bad. He had no way of getting into the office. So I said, 'Fine, I'll come to the house and take the staples out.'"

Afterwards, he reflected, "You know, it's not that bad." Now, whenever he sees the need, he makes house calls.

For instance, his "in-person" visit allows him to diagnose problems, plan treatment and monitor the problem. "I'll perform wound checks, suture or staple removals, or if a patient calls complaining of symptoms I don't feel warrants an X-ray or a visit to the emergency room, I'll be at their home," explains Dr. Krishnamurthy. "Or, if it's just not safe for them to get to the office, I'll be there."

He doesn't go around "advertising" this old-fashioned way of practicing medicine either. Rather, he says, "I do it when I feel it's clinically necessary or from an empathy point-of-view-when it's appropriate. It helps them and helps us, especially if they can't get to the hospital after surgery."

Many of his patients are elderly, "usually the 90- to 93-year-old independent types," who have "never made demands subsequently" for continued home visits. Dr. Krishnamurthy also goes to nursing homes to conduct post-op visits.

Across the board, he doesn't make house calls for "just anybody," such as a healthy person. "That, I think, would be an abuse." Or if Dr. Krishnamurthy finds the house visit is not going to allow him to do what's medically necessary, "if the patient needs X-rays or other testing," he says going to their house would not be "beneficial to them."

Of his five partners, Steven Small, MD, also emulates his colleague's good Samaritan ways. Between the two, they conduct about 30 house calls yearly. Since home visits are not a "planned activity," and done on more of an "as-needed," basis, Dr. Krishnamurthy uses "any free time" such as lunch hours. "I wouldn't go in the wee hours of the morning because if it's an emergency, then they would have to be seen in a more structured set-up," he says.

Although making house calls naturally builds a good patient-physician rapport and is a useful marketing tool, the latter never crossed his mind. "The geriatric patients need this service," he says. "They come back-if that's any indication [of marketing success]."

Dr. Krishnamurthy also spends "a little time" chatting with them. "A lot of them are quite lonely," he says.

As far as charging extra for home visits, Dr. Krishnamurthy says, "We've never specially billed for this as a code. A lot of times it comes under the umbrella as post-op care. In those instances where it doesn't, we've never bothered billing-and we're not going to."

Fears of liability do not daunt him. "What liability, the only thing that can happen is that I might fall," he says.

Dr. Krishnamurthy adds, "We don't want to make it look like we're knights in shining armor." Yet, he says house calls should be "practiced more often.

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