Focus
Student Scene
February 14, 2000
What Students Take Home from a Patient Home Visit
By Erica Seiguer
My first thought about the home visit was who would let a couple of first–year medical students come to their home on a Saturday morning to talk about their medical condition? There we were, though, having traveled by T, by bus, and on foot, with a map of the area downloaded from the Internet, to meet our patient, Ms. X, as part of the course PatientÐDoctor I. Despite a brief snafu that had us going the wrong way on the T, we made it to Ms. X's home on time and were welcomed with a memorable warmth.
The home visit in Patient–Doctor serves many purposes. It impresses upon students the importance of the physical environment of our patients—we learn how and where they live, who they live with, and what it is like for them to come home every day. Is the neighborhood safe? Is their house clean and neat? Is it well heated? These are parts of the patient's story that may not come out as vividly—or sometimes at all—during an interview in the physician's office.
Visiting patients in their own environment also tends to shift the traditional power structure of the doctor–patient relationship. In the home visit, it is the physician who is on unfamiliar terrain and the patient who is more comfortable.
If the home is a reflection of the patients themselves, what can we learn about them, and how does this affect our assessment of their health and their ability to cope with their illness? How can we use this knowledge to be more effective physicians?
Patients Become People
Ms. X's gracious personality immediately set the tone for what would be a wonderful conversation. The apartment was decorated for Christmas with a beautifully adorned tree with presents underneath and music playing softly in the background. We took off our coats and sat down on the couch. Before we knew it, we had already begun a discussion of her health status and, specifically, her ardent desire to become a mother for a second time. Ms. X exuded optimism and ambition, and I felt energized just being around her.
We learned about her career in her Caribbean homeland before she came to live in Boston. We learned about how she laid down the law with her daughter's boyfriend. We learned about what she liked and did not like about her job and about the party she threw on Sunday night that featured her traditional goat stew. We leafed through pictures of the latest family gathering, admired a card her mother had given her, and took a tour of the apartment. We talked about the difference between American culture and that of her native country. We talked about her hopes for the future, her desire to have a child, and her interaction with the medical profession. Before we left, about an hour and a half later, Ms. X had invited us to return for some traditional Caribbean food. And as we left, we had no doubt about what a wonderful mother she was and could be.
Does It Matter?
So what can medical students, with only anatomy and biochemistry under their belts, learn from a home visit? And can anything we learn by talking with patients in their homes change the course of their treatment? I think it can—eventually.
What we take away from this experience is partly a reminder that every patient we interview at the hospital—and all the patients we will interview and treat in the future—have homes and home lives just like Ms. X. The home visit makes us even more aware of how much we must learn about patients and their lives just from the questions we ask them in the hospital, and to what extent their answers may have bearing on the treatments we prescribe.