2025

When I was a young, idealistic premedical student, I inadvertently became a medical voluntourist—an often dismissive term for someone who combines vacationing with rendering short-term volunteer aid.

Picture a bright-eyed American student headed for a foreign country in the hope of contributing to saving lives. My group traveled through a jungle to get to a location that the director of this study-abroad opportunity had described as a remote village, with a patient who needed a house call. Pure excitement, angst, and joy bubbled from us throughout the trek—but nothing prepared us for what we would inadvertently do.

In medical school, the importance of monitoring vital signs, labs, and disease markers was drilled into our brains. When these numbers were sub-par, we were told to advise folks to “eat less processed food,” “get more exercise,” “take your meds as prescribed,” etc. It becomes easy to fall into the trap of treating the humans sitting across from us in the exam room as the total of their labs and vitals. But for many patients, other factors are just as important. Some cannot easily eat well or bathe themselves, so they ask their PCP to find home health care to assist them with food shopping, meal preparation, laundry, and basic housework.

“Doctor, he cannot be moved. Could you arrange to see him at home?” Admittedly, a request like that is almost never exactly welcome at first blush. Sometimes, you know such an appointment can be managed from a distance (if the patient’s problem isn’t serious). More often, you worry about practical difficulties (how to find the home—now much easier since the advent of GPS; whether there will be a convenient parking space; how much can you do without your usual office facilities; and, most importantly, how you’re going to carve out the necessary time—several multiples of a routine office visit—from your already busy workday).

In practice however, you rarely regret a home visit. Once you overcome your hesitation, and the practical obstacles, you get to know your patients in a different light when you see them in their own daily environment, which certainly impacts on their health and quality of life in many ways.

The loneliest existence I have ever encountered was a hospital room that briefly held an elderly man.

At report, there were no significant signs suggesting his inevitable outcome. I began my first rounds as I had done thousands of nights before. I checked on him and introduced myself. His response was lackadaisical, perhaps even whimsical. Nothing stood out. No red flags caught my attention.

I’ve been working for over five years in home-based primary care division of geriatrics. As a physician assistant (PA), I don’t have to stay in one specialty for my whole career. Many PA friends from graduate school have transitioned between fields: cardiology, bone marrow transplant, neuro ICU, critical care, OB-GYN, dermatology, oncology, and so on. Why haven’t I switched to something more glamorous or exciting? The answer is almost impossible to capture in words, but I’ll give it a try…