In 1930, 40 percent of all doctor–patient visits were house calls. By 1980, the proportion had dwindled to less than 1 percent. Even in the 1990s, in the midst of an explosion in the home care business, the number of house calls continued to drop. At conferences, home care professionals were reported to laugh outright at the mere mention of physician involvement in home care.

Doctors approach house calls much as politicians approach campaign finance reforms: everyone thinks they're a good idea, but few do anything to support them. A major reason, not surprisingly, is money. Traveling to patients' homes is inefficient and is rarely profitable. Another reason is lack of training. Few medical schools or residency programs expose trainees to house calls. This lack of mentoring virtually ensures that young doctors won't take up the practice once they go out on their own.

I’ll never forget my first house call. In truth, it wasn’t entirely my idea. The patient, Roberto Gonzalez, had prostate cancer that had spread to the bones. He had been coming to see me with his wife at least once a month throughout the fall and winter, but he had missed his last couple of clinic appointments. One afternoon I got a call from his visiting nurse. I had never spoken with her before. (Admittedly, I had even been a bit lax about filling out the home-care order forms that were periodically put into my mailbox.) “He’s getting sicker,” the nurse told me. “He would love to see you.”

“How can we get him into the office?” I asked sincerely. (Did she want me to fill out another transportation form?)

“You could pay him a visit,” she suggested delicately. It hadn’t even occurred to me. At no time during my education had I seen or heard of a doctor making a house call.

I went to see him one evening after work. His block in Spanish Harlem had the characteristic mix of pawnshops, check-cashing stores, and dilapidated storefronts painted with colorful murals. Children were jumping rope on the sidewalk in front of the building, while old men passed the time on a nearby stoop. Standing in my white coat, I rang the door buzzer. A teenage girl popped her head out of a fourth-floor window. “Dr. Jauhar is here!” she cried.

Inside, I ascended the cracking limestone staircase. It was a steep climb; no wonder he had been unable to come see me. At the top of the stairs, I was greeted by a shawl-covered woman in her sixties. She clasped my hand. “Thank you, Doctor,” she said. “Thank you for coming.”

The apartment was well kept and filled with Catholic adornments and the fragrance of potpourri. I followed his wife to his room. Mr. Gonzalez was lying in bed, wearing a diaper, his crumpled body barely making an impression on the crisp sheets. His lips and eyes were coated with crust, and his face was sunken. A plate of rice and beans was sitting on the bureau, untouched. “Dr. Jauhar is here,” his wife said. “He has come to see you.” He extended his hand weakly, and I held it. I asked him how he was feeling. “A little better,” he whispered. “But I’m sick of going in the bed. I’m sick of being a child.”

Instinctively, I reached for my stethoscope, but then I realized I had left it at the clinic. In fact, I had brought nothing with me: no penlight, no blood pressure cuff, no prescription pad, nothing. I looked up at his wife’s smiling face, wondering if she noticed.

Without my tools, I couldn’t follow my usual procedures, so I just sat at his bedside, stroking his hand. Afterward, in the kitchen, I sat with his wife and had a cup of tea. I asked her how she was holding up. “He wants me to wait on him hand and foot,” she said with a mixture of resentment and resignation.

“It takes a lot of love,” I said, not knowing how to respond.

“I don’t know if I love him so much anymore,” she replied matter-of-factly. “Now it’s more like I just take care of him.”

She took a sip from her cup. “He’s jealous that I’m up on my feet and he isn’t,” she said. “The other day I wanted to buy face cream, but I couldn’t go because he wouldn’t let me. When the grandkids come over, he says, ‘They came to see me.’” She shrugged, like it was not in her nature to deny him such a small victory. “You know what he said to me the other day? He said, ‘When I die, the spirit is going to come take you, too.’”

I nodded silently.

“That’s not love,” she said. “That’s egoista. You know what that means?” I could guess. “It’s everything for yourself.”

Mr. Gonzalez died at home a couple of months later. It was a while before I made another house call. What I remember most about that first one was how impotent I felt. Outside the familiar terrain of the clinic, with no equipment or physician backup or formal training to speak of, I didn’t know what to do. Later, when I mentioned the house call to a senior physician, he scolded me for having created a liability risk for the hospital by taking on this task without supervision from an attending physician. Overall, the experience seemed to have been at best a waste of time. So I was surprised when, two years later, I received a letter from Mrs. Gonzalez. “I just wanted to thank you again for coming to see my husband when he was ill,” she wrote. “My family and I will never forget what you did.” My small, reluctant act of kindness had made a lasting impression.

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