Why French doctors still make house calls

PARIS — The custom of doctors who make house calls is no relic from the past in France, but a more modern innovation.

In the summer of 1966, the doctor Marcel Lascar reported to work on a Monday and learned that one of his heart patients had died over the weekend because he couldn’t reach a physician. Lascar recalled that his bathroom had flooded one weekend and he had no trouble calling an emergency number for a repairman. Why couldn’t it work the same to reach for a doctor?

It turned out it could, and SOS Medecins was born. Today, the service boasts a network of about 1,000 full-time doctors, working through 60 regional associations and covering two thirds of the country, including the overseas departments, said Serge Smadja, the organization’s general secretary. More than 4 million calls per year yield some 2.5 million home visits by general practitioners who treat non-life-threatening illnesses ranging from high fevers to bronchitis, gastric pain to depression.

The doctors carry stethoscopes, but EKG machines, diagnostic equipment for urine samples or blood tests, and even vaccines are also part of the doctors’ wide-ranging arsenal.

In the complex web of French medical bureaucracy, door-to-door service seems straightforward. The cost is slightly more than the standard 22 euros for an office visit and it is reimbursed under the country’s universal health insurance plan. Smadja said patients widely use but don’t abuse the privilege because for most people, "it’s not fun for them to see a doctor.”

“This is the French model of national solidarity, which is expensive to taxpayers, since they are the ones who pay in the end, but that is the inherent quality of the system,” Smadja wrote in an e-mail message.

In fact, Smadja said, the services saves the government money by collaborating with other emergency services as well as the French Institute for Public Health Surveillance. Home visits reduce the burden on emergency rooms and ambulance services, keeping them from becoming unnecessarily overwhelmed, Smadja said.

The SAMU, or Emergency Medical Assistance Service, takes emergency calls, while SOS Medecins responds to non-emergencies, so that calls that don’t require immediate attention don’t hamper the critical care of others.

During the deadly 2003 heat wave, the government learned how valuable the home visits could be. Nearly 15,000 people died that August, many of them elderly.

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