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Independents' Day

Madam, I’m a GP, not a plumber

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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.



Readers' comments (16)

  • entirely agree, wonder how patients cope in other country like USA without home visit. Home visits are waste of time.

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  • I worked in Australia for 12 months - I did ONE home visit in the 12 months I was there. Same demographics as in my UK practice where I do at least one a day. $150 a visit strangely motivates people to get their own transport

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  • People do not appreciate the cost of 'just asking the GP to pop round, because they do not pay for it.

    I had 2 patients today who asked for a visit twice on the same day! One was a care home the other one because she was scared about what will happen overnight when we are closed and wanted to discuss her options.

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  • I had a patient ask for a home visit while standing at our reception desk. He was there for a leg dressing. He said he was far too unwell to wait for a GP to squeeze him in. The nurse who saw him that morning said he had a cold.

    He decided quite rightly that he did not need to be seen when I insisted he should attend in an afternoon slot down at the surgery.

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  • Bob Hodges

    Any system where it's cheaper to drag the doctor to you, than it is to get a taxi to the doctor is DOOMED.

    The home is also a less appropriate clinical environment.

    If only we could get the CQC to register patient's homes.........

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  • I'm very proud of our health care system's ability to allow sick patients the options to be seen at home for free. It's an astounding privilege which unfortunately our patients are abusing and will drive it to the point of extinction.

    Last week I saw Mr. terminal Cancer who was in such a pain he didn't sleep at all. He was grateful he could see the doctor who looked after him, including difficult chats about his death. I was quite happy to spend an hour of my day (most of which was in the traffic) to provide the much needed help. He has now passed away, quite peacefully thanks to DNs setting up the right treatment.

    On the other hand I'm dealing with a complaint from a patient who I've told I'm not a substitute for taxi fare. This after patient (upon my arrival, perfectly well and sheparding her dogs from out side to kitchen) said it was much easier than taking 3 buses and cheaper than £15 taxi fee!

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  • Tom Gillham

    Interesting conments. Of course visits to patients who are genuinely housebound and sick, or need palliative input, are wholly appropriate and a core part of GP work. I've been staggered by the misuse of the visit system by some of our patients and triaging such requests has provided an opportunity to challenge and modify expectations. I would encourage other practices to try this out, it makes for a fascinating audit.

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  • Now working in Australia, home visits are entirely at the discretion of the GP. Some GPs just don't do them at all and there's no obligation and no fear of complaint. I visit the extreme aged housebound, and palliative care patients only. Everyone else is seen at our clinic or we see them in our local A&E which we are fostered to cover. Not having to do unnecessary home visits is one of the advantages of working over here.

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  • Last week I was asked to visit a patient at home - when I turned up there was no-one in. I was close to calling the police (had she collapsed?) but a neighbour kindly pointed out that she had gone to bingo in a nearby town.

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  • Hello fellow human beings.Having read your comments I totally agree with you all, but lets not be too cynical about it, and always try to remember that there maybe some real genuine people who are really ill and cannot get to their local surgery.
    I would like make a little suggestion here. Before you go out on a call, do a little bit of research about those patients first?

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