It’s early Tuesday morning, and Dr. Joseph Ventimiglia is hard at work, trying to inch his Honda Civic north on a clogged Central Expressway in Dallas.
Finally he exits, weaves through a neighborhood and pulls up near a brick home.
From the car trunk he grabs a black bag stuffed with the tools of his trade: a blood pressure cuff, an ear thermometer and a laptop computer. Draped around his neck is a stethoscope. He rings the bell, greets homeowner Tom Turicchi and then heads into a nearby room.
“Why, hello Brother Joe,” says Mary Turicchi, 85, the family practice physician’s first patient of the day.
“How are you doing, Mary?” he says, giving her a hug.
Ventimiglia, 38, makes house calls. It’s his way of treating patients who might otherwise go without routine medical care because they are either too sick or physically unable to make office visits.
His patients are mostly elderly. They rely on Ventimiglia to listen to their breathing, check their temperatures and raise their spirits. They call him Dr. V, and they expect him to sit at their kitchen tables, sipping coffee and eating lunch while he lends a sympathetic ear to a spouse who has no one to tell his deepest worries about caring for a sick loved one.
With modern medical technology requiring fancy equipment and a rapidly changing medical care system, most young doctors are unlikely to see patients outside of their offices. House calls are reserved for the old-timers, doctors who are slipping away without young recruits to take their place.
Ventimiglia gets $90 per call and is paid either through private insurance or with Medicare payments. In the past three years, those payments have increased 33 percent, a fact that he hopes will encourage other doctors to consider making home visits.
Still, a doctor who makes house calls earns far less than others; those who work in an office can see far more patients a day. But for those who believe in house calls, money isn’t everything.
“There are usually more advantages,” says Ventimiglia. “It’s a more intimate medical encounter. You are right in their home. You see their photos on the wall, and I spend more time with them. And food is definitely one of the nicer fringe benefits.”
So Ventimiglia, once a private practice physician who did nothing but house calls, now squeezes in the visits at least one day a week as an assistant professor of family practice at University of Texas Southwestern Medical Center at Dallas.
When he comes to see patients, as he has come to see Turicchi, he often brings along residents or interns in hopes of infusing them with his passion. That is why Dr. Ashley So, a second-year resident, has come along.
“There is a certain evangelism involved,” he says about his work. “I want others to know that this is a feasible thing to do and it is a good thing for the patients.”
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He stumbled into making house calls nearly four years ago while treating a patient. During a routine visit, the woman asked if he would see her son.
Then almost 21, the young man suffered from a degenerative neurological disease and was homebound. After his 21st birthday, he would lose his doctor because his pediatric physicians thought they could no longer help him.
The family lived five blocks from Ventimiglia’s office.
“It just seemed like a needed service,” he says.
For a while, Ventimiglia only saw patients at home. To do so, he had to find ways to make it financially feasible. He learned to group visits by geographical areas so he could see more patients. He turned to a laptop and portable printer to get paperwork done. He kept his office costs to a bare minimum.
He left the practice when he moved briefly to College Station, Texas. When he returned, several of his patients were eager to have him back. Now, on most Tuesdays, he turns his car into his office, takes along a student and makes visits.
“I want to talk to you about your emotions and I also want to look at your walking and your gait and talk about when you might need to use the walker,” Ventimiglia tells Turicchi.
A recent widow, Turicchi was once so depressed that she often cried through Ventimiglia’s visits. Lately, she has been feeling better.
Her appetite has returned, and her crying is now limited to once a day. But her walking isn’t so good. Unsteady on her feet, she often feels as if she might fall.
“With thinning bones if you were to fall, you could break your hip, and you don’t want to do that,” Ventimiglia says.
“Oh no, that would be curtains,” Turicchi agrees.
Ventimiglia tells her its time to use a walker. With none available, he turns to a nearby wheelchair, using it to teach her how to lean forward, placing her weight against the sturdy metal so that it will support her if she were to fall.
Together, they walk through the house. He gently coaches her while she practices.
Tom Turicchi says that he has seen great improvement since Ventimiglia started seeing his mother. He moved his mother and father to Dallas from Rhode Island when their health began to fail. His father died last year.
“He was here during the time my father was dying. He was wonderful with my mother and the family, before, during and after. He was able to be a source of healing for her, not in the sense of giving her a pill but that he could talk to her,” Tom Turicchi says.
Not all of Ventimiglia’s tasks are pleasant. There are patients who have no family support, abandoned in their old age and left to struggle alone with daily tasks.
“It’s so nice to see families like that,” says So about the Turicchis. “She has good support. You don’t always see that, and it is so sad.”