About 300 people in the Fort Lauderdale, Fla., area are fortunate to be in the care of self-described patient advocate Dr. Randolph J. Swiller, an internist and psychiatrist who ministers to his patients in their homes.
In fact, Dr. Swiller's practice is made up almost exclusively of home visits. “I find that I can be of greater help to my patients this way. Many are bedridden or homebound due to advanced age, physical impairment, or mental problems such as social phobia and panic disorder,” he said in an interview.
“Also, some patients are just plain uncomfortable sitting in a doctor's office. So I closed my office 2 years ago and started doing patient rounds in my car full time, 7 days a week,” said Dr. Swiller, who began his solo practice 24 years ago.
He now sees patients within a 50-mile radius of Fort Lauderdale. His wife, Tina, helps with bookkeeping and patient records. “Our visits are quite productive. I learn about my patients' lives at home, and I have an easy time monitoring their medications,” he explained.
Dr. Swiller's “black bag” contains just about everything he needs to conduct a basic physical exam, draw blood, or get an ECG. When further tests are required, he sends patients to an imaging center or hospital.
When he has to provide therapy to a patient who lives in a family setting where privacy is hard to come by, he sees the patient in office space that he sublets from another physician. This same office space is used when a patient's insurance won't reimburse for home treatment.
Uninsured and low-income patients are allowed to pay Dr. Swiller what they can afford, on a sliding scale spread over weeks or months. “I'm not interested in making a lot of money. … I'm only interested in taking care of people and making them feel comfortable.”
Dr. Swiller makes a point of contacting patients at least 1 day before going to their homes. “One of my patients is an 86-year-old woman who was robbed by two men posing as meter readers, and now she's afraid to let anyone in her house. I call her and her friends in advance, and the friends join me at her house,” he said.
Home visitation is one way physicians can reclaim the high ground in medicine, said Dr. Swiller, who added that he believes the profession has become time-centric and impersonal.