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CAMHS won't see you now

Home visits are the true rite of passage for medical students

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Well what can I teach you about general practice then?

Let’s start by learning how to perform a left handed rectal examination on a confused patient lying on a sagging sofa, with Jeremy Kyle blaring out from the corner of the room and a truculent Scottie dog snapping at your ankles.

A home visit is like trying to fix a car in the fast lane of the M25 at rush hour in a thunderstorm

I’ve recently started teaching medical students again, one of the rare gems of fun studding the steaming pile of ordure that general practice is becoming. It is a pleasure and privilege to introduce these young and enthusiastic minds to the rough end of the trenches.

The experience of assessing a patient in general practice has about as much in common with assessing a patient in hospital as Jeremy Hunt does with a rational, reasonable human.

The hospital has patients tucked up under fresh sheets in a bed set at working height. By the time they are in hospital a patient will have given their history several times and like a well-rehearsed actor, can often give a fluid performance.

This is a world away from the chaotic ramblings they will have treated their family doctor to - yes they really didn’t think it was important to mention to us they had just spent six months in Central America, what relevance could that possibly have to their fevers? (Yes, ok I know, we should have asked.)

I think the home visit is the true rite of passage for a medical student.

Home visits are often compared to fixing a car by the side of the road instead of in a garage. Around here I’d say a home visit is more like trying to fix a car in the fast lane of the M25 at rush hour in a thunderstorm, with the owner of the car repeatedly slamming the bonnet lid down on your fingers.

No nursing charts and plumped up pillows, but plenty of profoundly deaf octogenarians slumped in stained arm chairs with only well used incontinence pads to protect their modesty.

Perform urinalysis? Good idea, where?

The kitchen sink with the defrosting chicken in seems to be the only place available.

Wash your hands after? Excellent, now you have a fragment of fossilised soap and a towel that a microbiologist could write a PhD about to assist you with that task.

I’m not sure my students will necessarily want to join the ranks of Hunt’s 5,000, but they will certainly learn there is more to general practice than signing forms for parachutists.

Dr David Turner is a GP in west London

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Readers' comments (14)

  • Kevin Hinkley

    wonderful blog, thank you

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  • When I was a student I found home visits to be a huge privilege- it felt pretty special to be allowed into people's own spaces rather than them coming to mine. So thank you for introducing students to that!
    (have since quit medicine, but enjoyed that aspect very much)

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  • I hate home visits.

    Unnecessary, difficult, stressful, very time consuming and a dinosaur relic of a failed NHS.

    I have far too much to do in-house and always felt another service should be commissioned to do visits leaving me to do all the in-house stuff that needs doing.

    No other country does them.

    Cardigans I'm sure you will recoil in horror - you probably do 3 sessions and sit on a CCG board, I do 9 sessions 20+ years so time management is crucial, and visits get in the way of that.

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  • 10.07

    hear hear visits an anachronism in a failing health service.

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  • Marvellous :-)..and yet the sheep keep entering General Practice.Why??

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  • I like home visits - when they are necesary. I enjoy seeing my palliative care patients with time to talk. It allows me to practice proper medicine without the constant interuptions and pressure of numbers in surgery. And no, I do 10 sessions a week, have been a partner for 28 years, and until last year also did out of hours every Saturday night - doing nothing but home visits. I also do a regular weekly round at a local nursing home which is also a complete pleasure and allows me to control the polypharmacy that is inflicted on these patients on leaving hospital.

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  • Thanks! It's so true.

    Home visits may be a poor use of our time, but I can think of a dozen other obligations of modern general practice that I'd gladly get rid of before giving up home visits.

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  • Home visits can be of immense value to all parties, but all too often are an excuse for lack of transport.
    It always amazes me how many such individuals can be encountered in the local supermarket or hairdressers.

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  • Going to the hairdresser at 1, but HV please before.
    Takes 1 hour + in rural areas like mine. Nursing homes routinely request HV for mobile patients.
    I just think it takes so much time.
    1pm HV up the mountain. 4pm HV next door.
    I just hate HV.

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