Dr. Rosanne Demanski, N.D.

Webster's dictionary limits the definition of medicine to "The science of healing, or, a substance used in the treatment and prevention of disease..." "Substance" for healing is a too narrow definition. For me, medicine has become more than a mere tangible that is administered at regular intervals. It has become more than an entity that functions solely in the realm of cause and effect.

True medicine is a dynamic interaction between patient and doctor, a cyclic exchange of energy on many levels, and the substance, sometimes useful, only serves as a catalyst. Too often, today's medical practice is limited to starchy summaries of diagnosis and treatment, and the aseptic, stereotypical office. For better or worse, an office provides an environment where the distinction between doctor and patient is implicit. The fixtures, the lights, the large desk looming beyond the imposing chair, the file cabinets full of charts - all these help to reinforce the formality which has become the patients' and doctors', expectation for the physician's office.

There are many good points to having an office. An office allows for efficiency. Patients come to the office during the hours the doctor is available. All equipment needed for blood draws, exams, pharmacy, and other procedures is on hand. Everything is where it should be, and no time is spent hunting for makeshift tools. Proud plaques hang distinctly behind the comfortable chair that sits at that large oak desk announcing the physician's hard work and credentials. Concerns for personal safety are at a relative minimum in the office setting. Most patients who come through the office have some degree of education and are versed in social and cultural mores.

Having an office affords the physician permission to separate personal from professional responsibilities - if only for a short time. Yet, before embarking on focusing myself on a large medical office, with all the amenities described above, I decided to incorporate housecalls into my practice. The following is a typical story.

Not long ago, I walked through the darkly stained wooden doorway of a client's home, into the large room, with tonka trucks and baby dolls strewn across the floor. I remembered again the feeling of noticing the lack of rows of people waiting in wooden chairs as I prepared to do my work. Instead, a woman came out to greet me with a pot of herbal tea, her belly swollen with nine months of pregnancy, and two toddlers trailing behind. Gratefully accepting the tea, I set my black bag down on the ragged rug and sat beside her. We talked about her garden, her house, and her family. When she was finally ready, she tearfully began to discuss her health and her fears. I was able to observe her and respond to her in an environment where she was not intimidated. She clung to an embroidered pillow as she cried and looked around her living room, settling her eyes on objects of personal comfort.

Because the illusion of separation from our patients, and the tacit "power" one attains from being a physician, dissolved as I sat with her, the typical role of being a doctor shifted and the magnificence of being a sister human, with knowledge about health and healing, took form. Between sips of tea, her tears and tissues, and reading "Jump Frog, Jump" to the children, I collected a medical history, did a brief exam, drew blood, and mixed some herbal preparations to use in conjunction with various diet recommendations. The total time spent there was one and a half hours.

There are numerous benefits to both doctor and patient inherent in the housecall. The patient has more privacy in a housecall and doesn't have to sit in an office and endure questioning glances from other patients. Another patient with whom I am doing counseling and nutritional work once said to me, "In an office, I feel I have to say something to the person beside me, when in fact, I don't feel like talking, or I'm worried about my condition."

Present day physicians have become specialized in certain areas of expertise and remain confined to their institutions of practice. Although reaching out to the community has become difficult in our society due to a large population, the isolation created by technology, and increasing threats of malpractice. However there are still basic functions that physicians may perform for patients in a housecall setting. These functions revolve around humane concern, and will help to dispel the impression that today's physicians have become part of an exclusive community of professionals where interpersonal service is viewed with frank skepticism.

Perhaps many modern-day physicians fear they will lose their objectivity if they interact too closely with their patients. Ironically, this need for security of distance often prevents them from accessing the core need of their client, and undermines the traditional role of a physician as someone who cares not only for the body, but for the whole person. Being a physician requires certain qualities: the patience to know that things may take longer than expected, the humility to realize we are there to serve, and the integrity to practice with the patient's best interest in mind.

Doctors must have the vision to see the life of the patient beyond the physical's realms, and the trust to act on that vision. If these virtues are truly an integral part of the doctor's constitution, they will prevail whether during a housecall or in the office. A physician from a large hospital told me, "If they don't come, they won't get helped." He was referring to patients who couldn't keep their appointments due to changes in the bus schedule. While there are many people who will come to doctors and get well, what about those who cannot come because of age, handicap, illness or financial stress? These people become the forgotten ones who do not get treated.

Housecalls can contribute to making health care possible for everyone because they help expand the boundaries of the health care system, and ensure that care is not limited to medical care. Naturopaths are in a prime position for this service because we can use our eclectic natural therapeutics appropriately in a home setting to apply immediate and prophylactic treatment. We have the capability to treat almost anyone, almost anywhere. Setting out to make housecalls, I bring by black bag stuffed with diagnostic tools, laboratory kits, and medicines. There are occasions however, when I don't have all I need. I may shuffle through the patient's kitchen, looking for bowls and cloths for use in hydrotherapy, strainers for tea, or other miscellaneous makeshift treatment items.

Sometimes carrying medical items, especially medicines, is risky. Usually, I know my patients before visiting them in their homes, but sometimes I get paged to the home of someone I don't know, maybe in a questionable part of town, maybe late at night. Nonetheless, I disguise my doctor bag by packing it in a beat up paper bag and then park as close to my destination as possible. On one occasion that required such precautions I had to walk through a dimly lit hall, brimming with loud music and smoke, guided by the older brother of the patient. I treated his young sibling for fever with a cold sheet wrap and administered ear drops for his otitis. There were no endearing hugs good-bye, but as I was escorted to my car, there was a simple, yet warm, exchange of glances from the family as I left.

Finally, by doing housecalls, I am able to educate patients in their homes as to how they can use their own resources to care for themselves in a variety of circumstances - minor fever, cuts, coughs - - and thereby help to empower them with control over maintaining health. I require my patients to call me before commencing treatments on their own, but I encourage them to use the therapeutics I have shared with them in subsequent times of need. Often, while on a housecall, the patient and I will go through their cabinets and make notes about how to use herbs they may have, or how to do such treatments as an oatmeal bath or wet sock treatment for fever. While at first this may seem time consuming, it proves otherwise in the long run when I remind them by phone how to use these treatments.

The reason I became a doctor was to serve, and doing housecalls is one of the most intimate forms of service I can provide. In our rapidly changing world, I see the need for unity and for the cultivation of a genuine caring for each other. I have found that by reaching beyond the confines of my sterile office into the community I am doing what I can to maintain our connectedness to one another while helping enhance quality of life for all whom I contact.​