Sore throat is one of the most common reasons that patients call us. For those who have never utilized our services, this is how it works when we are asked to treat a patient with a sore throat.
Why a house call for this problem?
Patients usually call us because they are busy and cannot wait for a delayed appointment time with their doctor. They often do not want to travel, sit in their doctor’s waiting room, then stop and potentially wait at the pharmacy for prescribed medicine. Many patients with sore throat feel feverish, weak, fatigued, and simply want to stay at home where they are comfortable and can rest. Some patients experience nausea and/or vomiting with their sore throat and prefer to stay at home where they may have easy access to the bathroom. Patients may have severe pain so that they are unable to swallow food or liquids. These patients may become significantly dehydrated, so that travel becomes difficult due, again, to weakness and fatigue. Many of our patients tell us that they do not want to be exposed to other infectious patients in public waiting rooms. Patients with serious or life-threatening conditions should always go to their nearest emergency department or call 9-1-1.
When a housecall is requested
When the patient, or requester calls us, a doctor will ask them questions to immediately determine the appropriateness of the house call. If the physician feels that the patient would be better served in the ER, the caller will be advised of this. Once both parties agree to the house call response, the patient’s name, location, and contact information will be recorded and an arrival time will be estimated. In most cases, the doctor will arrive within the hour, however arrival is always subject to traffic conditions, and any prior scheduled requests. Appointments are made on a first-come-first-served basis.
What we bring
When the doctor arrives at the patient’s home, hotel or workplace, he or she will arrive with whatever medications, equipment or lab tests are needed to evaluate and treat the patient so that after the visit is complete, the patient will be able to remain at rest. The patient always has the option to have prescriptions filled at a nearby pharmacy of choice.
The medical evaluation
For sore throats, usually a quick history and physical exam are all that are needed. The doctor carries a stethoscope, thermometer, pulse oximeter, sphygmomanometer(blood pressure measurement) and otoscope to use for the initial exam. Occasionally a strep test may be performed, although this is usually not necessary. Instant influenza tests are usually carried by our house call physicians during the winter months.
Antibiotics may be determined to be appropriate in many cases, and may be dispensed directly, or a written or telephoned prescription will be provided. Injectable antibiotics may be offered in some situations. Other medications may be required as well. Since many cases of sore throat are caused by viruses, not bacteria, antibiotics may be offered on a wait and see approach. With this strategy, the idea is to avoid antibiotics for a brief period of time, then to call in a prescription to the pharmacy if the patients symptoms begin to worsen or if no improvement occurs after a period of time. This approach is commonly used by many medical providers, and has helped to minimize antibiotic over-usage. Certain cases of sore throat with significant swelling may benefit from steroid treatment with prednisone. This medication may be provided for appropriate situations.
How we handle more serious cases of sore throat
Occasionally patients many be found to have a more serious cause of sore throat such as abscess. These conditions require immediate or urgent drainage procedures . These patients will require immediate referral to an otolaryngologist or to the emergency department. We will always facilitate these arrangements for the patient for your convenience and safety.
Sore thoat caused by mononucleosis is diagnosed via blood testing. Our house call providers can arrange for this evaluation through a nearby laboratory. The house call physician may offer to draw blood and then transport it to the lab for processing. In many cases this testing is best to perform at least 1 week after the onset of illness. The house call doctor will recommend the optimal strategy.
Insurance, paperwork, and payment
Once the examination is finished and treatment plan determined, a superbill form will be given to the patient. This form may be submitted to insurance providers for reimbursement if coverage is maintained. Payment for the housecall visit is accepted via cash, credit card, or invoice for pre-authorized insurance plans(traveler insurance plans). Flexible Spending Account (FLEX) and Health Savings Acount (HSA) credit cards may be used.
A typical house call for patients with sore throat is $265 within San Francisco before 5pm weekdays. For services during afterhours, nights and on weekends, an additional fee applies. Medications that we dispense are typically $20-$80, or patients may just pay their insurance copay by going to the pharmacy directly. Occasionally an antibiotic inject may be preferred and fees are usually ~$100-$140. Additional charges may apply for any lab tests that are done. Again, for most cases tests will not be recommended. Physician travel fees are charged for services rendered outside of San Francisco, unless the doctor already is nearby. A house call fee estimate is always provided at the time of the initial service request.
Detailed instructions will be given to the patient, and in all cases patients may call us anytime, 24/7, to clarify instructions or discuss further care.