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There's so much more to rural medicine than making house calls across the picturesque countryside.

Fam Pract Manag. 2009;16(3):36

Dr. Cayley, an associate professor in the University of Wisconsin's Department of Family Medicine and Eau Claire Family Medicine Residency, practices at the Augusta Family Medicine Clinic. Author disclosure: nothing to disclose.

Driving down twisting, snowy roads searching for my patient's home, I pondered the irony in the passing landscape. Amish settled in this area south of town more than 30 years ago and are often thought of locally as “the quaint folk.” Here I was driving past fields and woods filled with Amish buggies, schools and farms to perform an almost equally quaint medical service – a house call. My patient, however, was not on an Amish farmstead and his situation was far from idyllic. He lived in a plain ranch house on a wooded lot in the care of family determined to see that his last days would not be spent in an institution.

It seems that just about every time I tell someone where I practice, they remark on the local Amish and ask questions such as, “Do you get paid in chickens and handmade furniture?” I get a similar reaction when it comes up in conversation that I make house calls. People seem to think of me as a quaint country doc, puttering around the countryside making house calls to picturesque farms, like a relic of a day gone by. If only they could see past these images and see the loneliness, determination, heartbreak and love that often lies at the heart of rural medicine.

There is nothing picturesque about visiting a disabled and dying elderly man at home. When diapers, bandages, urinals and other hospital paraphernalia have displaced the usual comforts of a home isolated in the woods, what really grabs you is the patience and love of a family who wants to keep on caring, even in the most basic of ways, to the very end.

A few miles up the road, another family cares for a severely disabled adult child. There is nothing quaint here about cleaning up drool, about regular skin care, about bowel programs or about lonely nights at home caring for a person unable to speak rather than going out to eat, to a movie or to play cards. Amidst the mess, however, this home is also a testament to determined and loving care. I've never seen anger or depression in these parents over hopes shattered by the tragedy of a profound childhood disability, only the steady day-today care it takes to keep a totally dependent person fed and groomed.

Are house calls quaint? Perhaps to some. To me, they are simply a tool, as useful as a stethoscope or an exam table. For disabled and homebound patients, it is often more practical for me to go to them rather than the other way around. There are also times when a house call can provide a useful window into the more hidden parts of someone's life. That elderly patient with progressive memory loss may actually cope very well at home, while another patient who lives alone might be completely confused by the multitude of medicine bottles huddled on his kitchen table.

I have occasionally paid visits to patients on Amish farms. The rough wood floors, the smoky smell of wood heat and the buggies parked in the yard do lend a certain old-time ambience. But when I went to see a young child with several days' cough and fever, it was not the ambience that struck me most but the worry of the young parents. Though we were of different cultures and backgrounds, the anguish in their faces easily cut across cultural barriers.

There are certainly aspects of small-town doctoring and rural house calls that some may consider quaint, but the reality is so much greater than that. If only people could see into my patients' lives. If only they could see the determination, patience and love that is often hidden in small houses on remote roads. If only they could see what is really at the heart of my work and what gives me the inspiration to keep at it each day.


The opinions expressed here do not necessarily represent those of FPM or our publisher, the American Academy of Family Physicians. We encourage you to share your views. Send comments to, or add your comments below.

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