A film by Ian McLeod; produced by Gerry Flahive
Every physician who cares for frail older people or has aging parents, relatives, and friends has much to learn from this film. It is a proverbial “must see.” This is especially true for those who have never had the enriching and transformative experience of making home visits to their patients who can no longer easily come to their offices because of their conditions. This 55-minute documentary provides at once a joyful and distressing glimpse into the lives of three people who call Mark Nowaczynski, MD, their doctor. It gives physicians the opportunity to get beyond the walls and isolations of hospitals and medical offices and reconnect with the humanity of their patients.
Dr Nowaczynski identifies himself as a passionate photographer and a committed physician who makes regular home visits to essentially homebound patients. Joe, age 86 years, has Parkinson’s disease and lives in his own home. Connie, age 93 years and partially blind, has a heart condition, recently fractured her arm; all this and her reluctance to allow someone help her bathe have her oscillating between her apartment and a retirement home she cannot afford. Ria, lives at home at age 90 years, and has severe osteoarthritis and pain in her knees.
The film is the result of Dr Nowaczynski’s desire to bring viewers into the hidden, solitary lives of older people who are so isolated that “Nobody knows they are there.” He also uses his photographs to demonstrate a compelling case to change the fee schedule of the National Health program of Canadia, which does not permit more than 20% of a physician’s billings to come from house calls. He wants to see a change in the current policy, which mandates that the elderly require bathing assistance before becoming eligible for any home support.
The video brings the viewer into the homes of these three wizened and very proud old people. The stories of Joe, Connie, and Ria are told through words and images. Their fierce independence, personal history, and daily challenges reveal the richness of their lives, as Dr Nowaczynski’s photographic images of them are revealed in the red glow of the dark room. They are not just patients with medical conditions. Simply said, they are people like the rest of us with pasts, presents, hopes, beliefs, and goals.
Joe is a crusty guy who lives with his cat, who makes a full pot of coffee every day hoping that someone just may drop in. Having invested wisely, he does not have the mindset to use some of his considerable assets to pay for help. He recounts the details of a recent bedtime fall. He lay on the floor all night and part of a day before being rescued by a friend who happened to come by. Joe rejects Dr Nowaczynski’s suggestion to buy one of “those scooter things” but accepts a walker that allows him to get beyond the outer limit of his world, his front porch.
Connie is living on the edge of independence with her cat Oscar, her “boyfriend,” who gives focus to her life. She sees herself as not much use to anybody. “I fill in the days … I would like to do more … I don’t do what I used to do.” Modesty keeps her from accepting the government-required assistance in bathing that is the ticket to additional support that will allow her to stay at home. She coyly asks Dr Nowaczynski if she could wear a bathing suit during a shower. As her photograph is taken she asks “Who in the world would want to see a bunch of pictures of me? Junk!” Despite Dr Nowaczynski’s advocacy and coaching, Connie rejects the help of an aide who arrives to bathe her and ends up living in an assisted-living facility—with Oscar and a piano on which she shows the talent she developed years earlier at the Toronto Conservatory.
Ria lives in her two-story house with the mementos of her life on the stage. She admits, “It hurts when you are left alone.” In her Germanic accent she recalls her earlier life on the stage as a little soubrette in operetta. She says she was never beautiful but she hopes she was good looking. She struggles to get off the sofa to painfully attempt to demonstrate the graceful movements of her earlier career: a curtsey, a laugh, a smile, and song and “The world is yours.” As she sits for her photographic portrait, Ria’s earlier days as a soubrette briefly come to life in her proud posture, creviced face, and the thrust of her jaw.
Medical care during recent decades seems gradually to have lost its way and much of its heart and compassion. Efficiency, throughput, and cost effectiveness have become the watchwords of success for many physicians, hospitals, and organizations. Relationships with one another and with patients seem to matter less. This development especially affects older adults who become frail and tend to spend most of their lives at home where even simple tasks become challenges. There seems to be no time to get to know patients and their worlds. Government agencies, professional organizations and physicians currently are striving to reverse this trend. They are trying to make care “patient centered” and attempting to create “medical homes.” I suspect the 55 minutes spent viewing House Calls will have more impact on quality of care, satisfaction, and physician-patient relations than most other efforts attempting to reconnect physicians with their roles as healers.