Among the many changes we’ve seen in the world of medicine in the last 100 years is what many people call the demise of the house call. There are still medical professionals who visit their patients (more on that in a bit). But you no longer really see the GP making the rounds as in the past. There are arguably several reasons for this. I’m no medical expert, but I would suspect that one of them is the increasing litigiousness in the medical world. Lawsuits are a very real issue for midwives, doctors, nurses and all sorts of other medical professionals; and home visits are often seen as unacceptable risks. There’s also the issue of money. Health care is expensive. No matter what sort of system your country has established for medical services, those costs have to be met. So it’s not feasible as it once was for a GP to visit patients. There are of course other reasons too.
There are plenty of crime-fictional doctors and nurses who make house calls. Those characters can be really interesting, as they see quite a lot and know many different people. Here are just a few to show you what I mean.
Perhaps the most famous is Arthur Conan Doyle’s Dr. Watson. After service in Afghanistan, Watson returns to London and sets up as a GP. It’s not easy going at first, and as we learn in A Study in Scarlet, Watson decides that the best thing to do is to share rooms with someone. That someone, of course, turns out to be Sherlock Holmes, and Watson soon begins to share in, and document, his cases. As the stories go on, Watson builds his clientele and eventually marries and moves into his own home. As fans know though, that doesn’t stop him being interested in Holmes’ doings. Although these adventures don’t generally focus on Watson and his life as a GP, there are several references to his doing rounds and visiting his patients.
Several of Agatha Christie’s novels include GPs who make house calls. In The Murder of Roger Ackroyd for instance, we are introduced to Dr. James Sheppard, who lives with his sister Caroline in the village of King’s Abbot. When Hercule Poirot retires (or so he thinks!) and moves into the house next door, Sheppard gets a chance to see the way the famous detective works. Retired business magnate Roger Ackroyd is stabbed one night in his study. The most likely suspect is Ackroyd’s stepson Captain Ralph Paton, and there’s evidence against him, too. But Paton’s fiancée Flora Ackroyd is convinced that that he is innocent. She persuades Poirot to take the case and he begins investigating. Sheppard knows everyone in the area (he was actually a friend of the victim’s), and gets involved in the investigation. I know, I know, fans of Sad Cypress.
John Bude’s The Cornish Coast Murder features a GP as one of the protagonists. Dr. Pendrill serves the community around the village of Greystokes. He’s having dinner one night with his friend Reverend Dodd when their evening is interrupted by a telephone call. Pendrill’s been summoned to Greylings, home of the Tregarthan family. Family patriarch Julius Tregarthan has been shot. By the time Dodd gets there it’s too late for him to be of any help to the patient. The police are alerted, and Inspector Bigswell and his team begin to investigate. They find that three shots were fired into the open window of the sitting room where the body was discovered. The shots came from three different angles, and the case turns out to be a bit tricky. The victim was one of Pendrill’s patients, and he’s curious anyway; so he takes an interest in finding out who the killer is, as does Dodd.
As I mentioned earlier, there are still some medical professionals who make house calls. For example, visiting nurses and midwives take medical care to their patients. We see that in crime fiction as well as in real life. In Catherine Green’s Deadly Admirer, for instance, we follow PI Kate Kinsella, who also works as an emergency room nurse. She takes on a troubling case for a client (and fellow nurse) Virginia Wootten. Wootten is a district nurse who is convinced that she’s being stalked. She isn’t certain of the stalker’s identity, but there’s no doubt in her mind that she’s a target. She doesn’t seem particularly credible, since she can’t be specific and she has a history of psychiatric problems. But Kinsella takes the case and begins asking questions. Then, one of Wootten’s patients is murdered, and a message left behind seems to implicate her. Then, there’s another murder; this time, the murderer leaves Wootten a threatening message. And that’s when Wootten herself disappears…
There’s also the recent development of what’s often called concierge medicine. In one way, it’s a return to the house call and private medical service. But there is one important (and controversial) difference. Many concierge services work in a way that’s reminiscent of having an attorney on retainer. Those with the means to do so pay a (usually large) yearly fee in order to ‘buy into’ the concierge. This gives them access to a wide variety of medical services, including home visits. There’s an argument that this means more doctors available for those with money, and far fewer for those who can’t afford the concierge fees. A lot of people see this as a real inequity, although not everyone agrees.
This is an issue that’s deal with in Robin Cook’s Crisis. In that novel, we meet Boston physician Dr. Craig Bowman. He’s gotten fed up with the pressure from insurance companies to see more and more patients and offer less and less care. So he joins an exclusive concierge group which he thinks will allow him to devote himself better to his patients. At first, all goes well. Bowman spends more time with his patients and can give them better service. And he’s earning more money, too. Then, one of his patients, Patience Stanhope, dies, and he finds himself the subject of a lawsuit. With so much at stake, Bowman’s estranged wife Angela calls on her brother Dr. Jack Stapleton for help. Stapleton is a New York City medical examiner who may be able to use his skills to show that Bowman was not responsible for what happened to the victim. Stapleton travels to Boston to help his sister, and finds himself drawn into a much deeper mystery than anyone thought. Along with the mystery that’s the main subject of the novel, there’s also a discussion of the ethics of concierge medical service.
Visiting doctors, nurses, midwives and other medical professionals have a fascinating perspective on a community. Little wonder they can make interesting fictional characters. Which ones have stayed with you?
*NOTE: The title of this post is the title of a song by J.J. Cale.