Home Visits: Advancing Pediatric Training By Preserving Past Traditions

* Abbreviations: ACGME — : Accreditation Council for Graduate Medical Education CSHCN — : children with special health care needs HCH — : home-centered healthAfter a short ride from resident clinic, we drove into 1 of the city’s low-income housing complexes. Walking up to the third floor of a dilapidated building and noticing the flimsy railing, we realized our anticipatory guidance on child proofing the home must also include outdoor areas. In fact, it was the motivation to see just how appropriate our recommendations were for families living in urban poverty that led us to join a community outreach worker on a routine home visit.When we arrived at apartment 3A, Janelle and her daughter Mia were warmly awaiting us. We followed them into a small living room where Mia, the fearless 2-year-old, quickly went back to her favorite game of jumping off the furniture. The sight of an easily accessible open window with no screen gave us pause, and we suggested several ways to prevent Mia from accidently falling out. Janelle, a first-time mom, thanked us for the advice. She soon became more relaxed and began speaking candidly about the importance of supporting her daughter. In the less personal atmosphere of a clinic examination room, the interaction with a young mother might not reveal the parent’s strengths, but by visiting Janelle in her home environment and watching her interactions with Mia, we could appreciate just how committed she was.Just over half a century ago, 40% of physician–patient encounters were in the home.1 It was … Address correspondence to Igor Shumskiy, MD, Boston Medical Center, 720 Harrison Ave, Boston, MA 02118. E-mail: igor.shumskiy{at}childrens.harvard.edu