Photo: Mike Itchue Retired Dr. Clement Cunningham made house calls in the Quad-Cities area from the 1940s through the 1960s. House calls have since decreased rapidly, although some say they are maiking a comeback.

Photo: Submitted Surgeons and nurses at Moline Public Hospital prepare for surgery in this 1900 photograph

As a young doctor practicing medicine in a different era, Clement Cunningham of Rock Island remembers the strangest house calls he ever made.

Once, he arrived at a house, and a patient "informed me that her favorite soap opera was on and I would have to wait" to treat her, he said.

Another time, the first thing he saw when he walked into a house was a gun on the kitchen table. The second thing he saw was a woman lying on the floor, bleeding from a gunshot wound in her stomach.

"To my knowledge, the woman survived," Dr. Cunningham said. "It was an accidental shooting."

Those types of bizarre situations, as well as regular, uneventful home checkups, used to be far more common for doctors like Dr. Cunningham, who once made house calls with regularity.

Today, the house call has all but disappeared, replaced by the more profitable doctor's office and the more technologically advanced hospital.

Dr. Cunningham cited developments in medical technology in the second half of the century as the main reason doctors slowly were forced to venture out of the office less and less.

"During those early days, physicians could provide the needed services by providing care in the home," he said. "As technology increased, so did the fact that a house call was not able to provide the necessary care that modern-day medical care could, and should, provide."

Among those technological advancements were the X-ray and, later, various other examination tools like the CT scan and MRI. As blood tests gradually yielded more information, blood labs needed more and more employees and fewer diagnoses from physicians.

Those developments offered doctors advanced exact methods for diagnosing previously tricky injuries and hard-to-diagnose tissue diseases. Also, emergency visits required faster reaction time than a doctor could provide with a house call, Dr. Cunningham said.

"One example is chest pain," he said. "The delay between coming over to the home to examine the patient before admitting the patient to a hospital compromised valuable minutes that might mean the difference whether they would survive a heart attack or not."

Finances also were an issue. Because of transportation restraints, a doctor might be able to see three or four patients in an hour in the office, but might be able to schedule only one house call during that time, thus lowering the number of patients he could treat in a day.

Also, once families began owning more than one car and motorized transportation became the norm and not the exception, the onus on doctors to travel to their patients became less pronounced, Dr. Cunningham said.

Today, doctors rarely leave their offices for routine checkups. That's likely to continue, although house-call training is undergoing a minor "revival," according to Bruce Leff and John R. Burton, doctors at Johns Hopkins University and authors of "The Future History of Home Care and Physician House Calls in the United States."

"Although physicians perform many fewer house calls than a half-century ago, there has been a recent revival in house-call training, education and practice," they write.

"However, the future history of home care will depend mostly on the ability of various stakeholders in the health-care system to recognize the value of home care and develop and implement the appropriate incentives to encourage its proper place in the U.S. health-care system."

For Dr. Cunningham, who served as a medic in World War II and returned to practice medicine in 1947, said it is difficult to imagine house calls reaching a level anywhere near their mid-century mark.

"It would be hard to see that home calls would be increased from where they stand today," he said. "There may surface a group of physicians who may stop seeing patients in an office and develop a service that would be limited to home calls only, but I would anticipate that this might be an expensive venture."