After the door opens and I exchange greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what filth people and animals deposit on the sidewalk, it seems careless to track it inside.

My second action is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag and clipboard. Apparently no one reads or writes while traveling, so belongings cover all surfaces.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can't hear. Guests often seem startled at this request – and occasionally miffed. What's the problem?.....

My fifth action, after listening to the patient, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.