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CAMHS won't see you now

Just like home

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Recently, on twitter, a GP posted a question to other health professionals – should we still be doing home visits?

It got me thinking and reflecting on a patient I had seen. She was in her 80s, and lived alone in a little cottage fairly far from the surgery, in the middle of the countryside. She had some memory loss, and it had been noted by previous GPs that had seen her that she could probably do with more help at home, but she had always cheerfully and adamantly refused this.

She’d been seen not long ago by another GP, with some vomiting and abdominal pain, that she wondered had some blood in it. She refused to go into hospital – she didn’t want to leave her beloved cat. She was actually well in herself at the time, – so the GP did some bloods and arranged to see her again the next day.

So I get a call from the lab at 5 o’clock – it’s always at 5 o’clock, isn’t it! – to tell me her haemoglobin was 6. My heart sinks because I know she won’t want to go in but I’m worried about her. I try to call but she doesn’t answer. She doesn’t have any family nearby at the moment. So I put on my coat and get my torch (a necessary addition to my doctor’s bag, working in the country!) and go and see her.

I walk up the muddy lane, and my shoes are filthy by the time I get there. I walk through the kitchen, automatically having a quick look round – I sometimes find the state of the kitchen is a bit of a barometer for how well someone is doing at home. She’s in bed when I arrive. She’s not looking well – she says the tummy pain has got worse over the last hour and she’s nauseous. She looks, as you might imagine, extremely pale. I see her pictures all around her bed – a sepia toned portrait of a handsome man in army uniform, plenty of her cat, and various babies that I assume are her grandchildren. Her nighties are neatly folded on her chair. Her adored cat winds around my ankles and then jumps up to join her on the bed. We talk about the blood tests, and how I think she should be in hospital. She understands, but looks scared. “What will happen to my cat? I can’t just leave…”

We talk about her worries. She says she doesn’t really want to go to hospital, she had a horrible time when she was there before she tells me. Noise all the time, overworked nurses and doctors, horrible food, needles upon needles, not sleeping, horrible smells, missing her cat. But… she hesitates… but she’s feeling pretty ill… she wouldn’t mind so long as I can sort out the cat. So I speak to the daughter, and she tells me of a local cattery that could have her while the lady is in hospital. I call for an ambulance and pack her a bag with her neatly folded nighties and books. I attempt to allay her concerns about going into hospital, but I am afraid that I can’t deny it’s probably not going to be pleasant. And I admit there will be needles involved. She relaxes a bit and settles into bed to wait for the ambulance.

So my meanderings here come to how much I actually enjoy home visits. I have always thought that they are one of the most integral parts of general practice. Of course it’s not feasible, or at all necessary, for home visits to be done for everyone – or indeed most - and there will always be some patients that expect a visit but honestly don’t need one. But for a subset of the population, it can be hugely valuable and, dare I say, a privilege.  Of course a great number of the people we need to invest the most time in – the elderly and those needing palliative care, as examples – will never be able to come to the surgery. To be able to enter people’s homes means you can see more of their lives than you ever would have done in the clean ordered atmosphere of our consulting rooms. I personally think the home visit is one of the most valuable parts of our profession and I’m grateful for the chance to continue to do them.

Dr Georgia Belam is a GP in Devon

Readers' comments (13)

  • How do they manage in Australia, Canada and every other country where home visits just do not occur?

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  • I agree home visits are very helpful for those who truely need it.

    Unfortunately there are many who abuse the system. I've had requests for
    "my mother is 80, she shouldn't have to come out to see you at her age"
    "weather is too cold"
    "I'm going to get a taxi from my girl friend to my home. I won't have enough money to get a taxi to yours after, can you see me at home"
    "I paid tax all my life, I think I should have some of what I put in back"
    "I can't possibly come to the surgery - but could you come after I've come back from my dentist"
    "It's too expensive to take a taxi, I already had to spend £15 on going to Xray department yesterday"
    "I came to your surgery this morning but you wouldn't see me as I was 20min late. I'd like a home visit now please"
    "Dr X (retired partner) always to come and see me once/month. Could you carry on and see me"
    "I've got 5 kids and it's difficult to get all of them in a taxi/bus, can you come and see me at home"

    I could go on..........

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  • In other countries its a nightmare. I know first hand from my Father being terminally ill in Canada and no home visits.

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  • Home visits? What are they? 6 years ago I went from working a full day to totally horizontal in bed, too weak and dizzy to even sit up. Home visit? No way. A vital opportunity for diagnosis and assessment was missed. I now know, 6 years later and looking at my blood test results and having taken diagnosis and treatment into my own hands, that I had suddenly become hypothyroid in the approach to the menopause.

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  • Having been a GP for 20 years, my opinion on home visits has never wavered - they are awful.
    Always have been.
    They are time consuming, often in bad traffic and bad weather, often unnecessary and take me away from what I need to be doing in-house.
    Last week I was forced to check that an old lady's pessary hadn't fallen out - and guess what, it hadn't.
    Whole thing took me an hour from one end of town to the other.
    What a complete waste of my time and expertise.
    I have had spells on call requiring 3 urgent home visits within an hour - I was 1 1/2 hrs late in surgery -the waiting booked patients were rightly furious - is this a good service to them?
    I've just returned from a grim flat where a salivating doberman nearly chewed my face off - and was advised 'just talk to him, he's fine'.
    Forget the Dr Findlay days of a GP 'doing their rounds'.
    Forget the touchy feely sandal wearing brigade who love home visits and can spot a non-verbal cue from 50 yards.
    This is a horrible new busy and nasty world where home visiting is a monstrous defunct old dinosaur.
    No one else in the world does it - just us mugs.
    Get rid of home visits for GPs.
    Yes, they have to be done, but not by GPs.
    Contract it out to someone else such as GPOOH for a loss of income.

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  • Increased access to GPs, you can see 3-6 patients oin surgery for 1 home visit.

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  • But what about the home visits that should be done and are dealt with by a telephone consultation, only to ring again a few days later to get another telephone consultation & then end up dialing 999 because the symptoms have not changed, the tablets the GP sent have not helped! There are 2 sides to every story.

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  • Home visits should stop. The opportunity cost - of not seeing 5-6 other patients probably means more harm occurs to others than the (dubious) benefit of the visit to one patinet.

    For every genuine home visit request I get, I would estimate I get 5 that are purely for convenience, and I then spend hours dealing with complaints and the distant daughter syndrome brigade who want their parents visiting but never visit themselves.

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  • I really don't mind doing the visit for patient that genuinely tried and could not get out of their home because their health dictates their mobility.

    Unfortunately patients abuse this previledge which is provided by sacrificing other patient's care for their convenience. At my surgery, approx 15-20 doctor hours are spent on visits every week - that's 90 to 120 more appoints/week if we didn't have to do visits. What a selfish society we have come to here.

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  • Oh I agree totally that there are many people that don't need visiting & should come to the surgery, & people shouldn't expect them if they don't need them. But I was meaning just those who genuinely can't - palliative care a very good example of where I think home visits from a GP can make a huge difference.

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