Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας Dagstuhl Seminar on Assisted Living Session III: Ethical, Social and Psychological Impacts Position Statement: Ethical, Social and Psychological aspects of the contemporary Hi-Tec House call Medical Practice Dr. rer. nat. Basile Spyropoulos Medical Instrumentation Technology Department, Faculty of Engineering, Technological Education Institute of Athens, Athens, Greece

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living2 What is a house call? We define a house call as an encounter between a patient and a physician in a private residence. Although house calls by physicians traditionally formed the core of home health care, their number has declined dramatically after World War II. However, during the last decade the house call is gradually going through a revival in the USA and elsewhere, and the demand for doctors examining patients in the bedroom will soar. The revival of house calls in Medical Practice is due, beyond the health-insurance adaptation to the altering social conditions, to the highly developed equipment made available to the General Physician of the emerging networked society.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living3 General Physician’s modern black-bag The Personal Digital Assistant, with embedded Cell-phone safekeeping detailed patient-records, and permitting Electronic Order Entry. The sophisticated point-of-care diagnostic equipment and reagents. Other technical means. allow for patient care, comparable to that of an emergency room, at home. The general physician on house call has to face various situations that may roughly be classified into three categories:

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living4 Emergency conditions Emergency conditions demanding either to be treated on site or after triage to be transferred to the Emergency Room. The main task for the physician, during an emergency house call, is to prevent:   Death   Or the irreparable and irreversible damage. to the patient.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living5 Follow-up cases Follow-up cases, usually persons discharged from a Hospital, after a major surgical or medical intervention. The follow-up period may vary from a few days up to several months, especially concerning chronic patients or patients in rehabilitation. A manifold of decisions are made before and after their discharge. The associated duties include decisions pertaining to:   The medical supervision.   And the administration of a long-term treatment.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living6 Terminally ill patients Terminally ill patients undergoing primarily palliative treatment, in order to relieve suffering and improve the quality of life for patients with advanced illnesses and their families. An interdisciplinary approach is needed that involves close attention to the psychological and practical social needs of the patients, of the people familiar to them, and of the patient’s caregiver. Communicating with patients is a core skill of palliative Medicine, especially in its most complicated facet, in pediatric palliative care, and conceivably the most important task for the house-caller physician. He has to elucidate the patient’s attitude about quality of life, by recognizing conditions under which the patient would consider life not worth living.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living7 What does a physician on house call need? Facing a wide spectrum of challenges the modern physician on house call needs:   First, a multifarious decision-making mechanism.   Second, the awareness to apply this mechanism on the basis of the uniqueness of the individual case.   Finally, he has to take into account that decisions in the context of health care, involve latent, as well as, explicit ethical parameters that complicate further his judgment and the consequent course of action.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living8 Important remarks It should be noted that this manifold of decisions is imbued with ethical dilemmas that a General Practitioner has to face, during a planned or an urgent house call, at every stage of the patient’s post Hospital treatment. Up to date, Health-care organizations are not intensively promoting programs of house calls by physicians, especially for sick elderly patients. House calls appear to still be far from the mainstream of current medical practice. Insurance and Managed-care organizations also did not have economic incentive to develop programs that will attract impaired and chronically ill patients, with the exception of pioneer countries like Germany, Scandinavia etc.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living9 Medical House-call can and will survive However, the emerging technical and managerial means, both, hardware and software, as we shall examine in details in the following sessions, seem to be able to save the old-fashioned, outdated, “inefficient”, but so valued in the Medical Community house call. Backed up by Biomedical Technology and Medical Informatics the medical profession will be able to support the allocation of the human and material resources, and most important, the time needed to sustain a valued and effective part of medical care that the frailest patients need and their families appreciate.