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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)

  • Home visits are sometimes the most rewarding experiences in general practice; they can provide additional information as to how patients are coping (or not coping) at home, and are frequently necessary in palliative care cases.

    They can, however, be a complete waste of time and resources. I audited our visit numbers and noticed a 33% rise in home visits over a 12 month period. With demands on the rise in every domain, this is clearly something that needs managed.

    One idea within the practice was to provide a practice-funded taxi service. I opposed this on the basis that I felt it would be impossible to implement fairly and ripe for abuse. One local practice is actually operating such a service, paying for taxis for patients who say they don't have transport to come up to the surgery as a means of avoiding the need to visit. Local OOH services also offer a similar service. They have reported success but I don't think this should be the GP's responsibility.

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  • Oh by the way I have taken up a new hobby (Teach yourself plumbing) I have notice that it is not much different from our own internal tubes and pipes with nuts,bolts and all

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  • Anonymous 11.19 am
    Obviously you are not a GP so not sure of the worth of your comment.
    COI- I am retired and so do not have to deal with these tiresome requests any more.

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  • I do visits on a daily basis - patients' home and nursing homes. These visits tend to be triaged by other GPs.

    My experience is that most of the patients' requests are unwarranted and are a waste of resources. They are mainly patients with unrealistic expectations or are manipulative. My sympathy goes to those that do really need it as they are the ones who tend not to call and they make up a minute proportion of all the visits I've done so far.

    The nursing home visits are at times ridiculous - mainly protocol driven.

    This doesn't do any good for the morale of doctors and resource allocation. There are way too many factors involved, but I feel a huge part of it is due to an evolving culture of high demands and blame/complains. This needs to be tackled but as usual, the sector is too fragmented to take a stand against what is the right thing to do here. It is then the doctors' who take the hits, and the genuine patients that suffer consequently.

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  • As a practice nurse, who sometimes helps out our GP's by triage of Home visit requests, I too, can relate to the above article. As others have suggested, there are many patients who have genuine needs, and def need to be seen, but the vast majority are clearly taking advantage of hard working, overstretched Gp's.

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  • The only home visit I ever requested for a 3 year old resulted in the GP knocking my door within 5 minutes, expressing my surprise at the speed my GP commented that 'when you see noted like these you know there is something wrong' The only entries in my childs' notes were for routine vaccinations. Enough said?

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