Posted by: Gillham2 April 2013
Let’s get this straight: home visits are often an infuriating waste of GP time. Only this week, the NHS confederation’s paper Tough Times, Tough Choices cited a German study demonstrating a 45% reduction in visit requests when patients were told they’d have to pay ten euros for the privilege. Challenged to consider the reasonability of their request, patients back down.
Muggins here offered to triage our own surgery’s visit requests on the basis that, experientially, most patients I visit do not need to be seen. Besides this, we simply don’t have the time to spare. So every morning from now on, an hour of my time is allocated to visit triage. It began on Monday. Patient High Expectations picks up the phone.
Hello, I say, it’s Dr Gillham. I was wondering if there was anything I could help you with over the telephone this morning?
Mrs Proudfoot-Smith does not understand the reason for the call. She sees Dr Darling routinely every six weeks, because she’s 97.
Is there anything you need to see a GP for today?
Well, not with you, young man, but tell Dr Darling his Earl Grey will be brewed by one. Good day.
Next up: Patient Manipulative. I’ve met him before. He’s got his own powered scooter, lives two minutes from the surgery and is still of working age (though he doesn’t work, of course). He can’t possibly attend: he’s had the squits since starting antibiotics for his rash five days ago. He’d like a GP to come out to ‘collect a sample’. I decline his request, suggest he stops the medicine and observes his symptoms. I’m frankly astonished that he thinks we have time just to pop in and retrieve his watery foul.
Third up with Patient Entirely Inappropriate, and I quickly wonder whether she had dialed the wrong number.
Hello, it’s Dr Gillham, how can I help this morning?
My carers are on strike and the heating’s off.
Right. Sorry to hear that. Was there anything you hoped a GP could do for you today?
Yes, have a look at the heating, my bungalow’s freezing. Have you contacted the warden?
Yes, she’s coming round now.
Right, so do you need to see a GP?
Well, the more the merrier and you might be able to mend the boiler.
I suggest that a GP visit may not be appropriate today, when challenged, she agrees. By the time I get to Patient Taking the P*ss, I’m on a roll. I didn’t stand a chance with Dr Darling’s darling, but my 66% reduction in attendance dwarfs the German study’s findings.
I’ve got a pain when I wee, the 45-year-old moans.
Can you get to surgery? I ask. I’ve got a slot at 4.10pm.
I don’t drive.
Right, how about a taxi?
I haven’t got any money.
The exchange gets slightly tense, but she agrees she’ll see what she can do. She duly turned up, incredibly well and perfectly mobile.
We’re all dealing with rising demands, but we cannot continue to pander to crazy expectations and outrageous requests. We’re partly to blame, of course: in our headless rush to get through the day, we go from house to house, unquestioning and duly reinforce the behaviour.
Often, those who ‘can’t get’ to surgery, can. Those who expect visits routinely expect too much.
And the day I drive 20 minutes to bag some antibiotic-induced rectal slop from Mr Manipulative is the day I sack off GP to re-train as a plumber.
Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.