LAUSR

On the cover of one of my medical education books, I recall the touching painting of "The Doctor" by Sir Luke Fildes. For long hours I scrutinized the meager home, the morning light caressing the young boy and the image of the devoted doctor, gazing with concentrated attention on the dying patient. I could imagine myself as that doctor, sitting beside his patient, after exhausting all of his efforts, awaiting the dawn, as if a miracle will pour down with the sun's first rays. Although there is seemingly nothing left to give, the doctor remains there for the boy and his parents. As a rural doctor, both my patients and I still enjoy the practice of home visits. Over the years of my practice, home visits have become increasingly out of favor in the eyes of policymakers. The hours dedicated to such visits have decreased and the HMO management prefers, for reasons of utility, to concentrate the medical care in regional clinics. "Virtual advisors" on the internet, Skype and the smartphone are replacing the doctor, his horse and his legendary black bag. Many have discussed the place of home visits in the twenty first century. I would like to emphasize one significant moral advantage: the home visit takes place in the "patient's territory." Issues of power vs. vulnerability and medical paternalism are replaced with more equal relations, in which decisions can be made collaboratively regarding the most important aspects of the client's life and health. This naturally occurs in home visits, for the doctor is the patient's guest, and the client and his family are the hosts. The doctor is outside of his comfort zone: out of his office, and away from his computer, his assessment tools, his secretary, his framed diplomas hanging on the wall. He comes to learn about the patient's home, culture and world view. Jack, a 47 year old alcoholic, single, lives alone at the edge of a field of thorns. After knocking on both the door and the windows with no reply, we push open the screen door thick with fly carcasses. Jack greets us half-dressed in shabby pants and sandals that have seen better days. He suffers from diabetic neuropathy and edema due to chronic heart failure. His left toe is already black and numb. We need to convince him to amputate it, before the