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Gold, incentives and meh

Are home visits a waste of time?

Home visits have no place in modern medicine, argues Dr Shaba Nabi, whereas Dr Justine Hall believes they are still an important part of holistic care

Dr Shaba Nabi

YES. They are an anachronism in modern medicine

As a GP trainer and educator, I should extol the virtues of the home visit; an opportunity to scrutinise our species in their own habitat. However, except when tending to the dying in their last few months, I feel visits are a total waste of time.

In the days before satnav, dead-ends and one-way streets would keep me driving around for hours trying to find a house. Nowadays, there is the additional headache of residents-only parking. I either risk a parking ticket or put a huge notice in my car announcing I am the visiting doctor.

Safety is an issue, too. Hundreds of hours are spent preparing for practice CQC inspections, yet no one is interested in our health and safety in someone else’s home. Hygiene probably bothers me more than anything else. Forget a bit of dust or a cluttered house – we’ve all visited people lying in their own faeces, while trying to dodge the animal excrement dotted around the carpet. And speaking of pets, the sound of a dog barking through the letterbox always sends shivers down my spine.

These may seem like superficial inconveniences, but not when you consider that home consultations are rarely of clinical benefit. Examinations can be impossible to do properly. As medical students, we were indoctrinated to examine patients from their right-hand side. Home visits allow us no such luxury and we are lucky if the patient is even lying down. An intimate examination can turn into a Pythonesque sketch; I recall once bringing in my head torch to perform a speculum examination.

Home consultations are rarely of clinical benefit

Home visits are also the means by which GPs become the dumping ground for any number of issues. I have been asked to certify dead bodies, to assess someone’s safety in their home and even to measure a patient for a wheelchair.

And that’s if the patient even answers the door. Are they a) at the hairdresser; b) still on their way to the door; c) lying on the floor with a broken hip; or d) dead? Will tomorrow’s Daily Fail headlines say ‘GP broke down door while Gladys was taking 40 winks’ or ‘GP left dead patient’s body to decompose for two weeks’?

I feel home visits need to be consigned to Dr Finlay’s Casebook – a fictional walk down memory lane, with no relevance in today’s climate of litigation.

Dr Shaba Nabi is a GP trainer in Bristol

 

Dr Justine Hall

NO. Seeing patients at home can be invaluable

Let’s face it, home visits are time consuming. In rural areas, it can mean a 30-minute drive each way. Even in urban areas, traffic and parking problems mean visits are never straightforward. Potentially hours of doctor time can be taken up just driving around. It is easy to say our time is better spent in the surgery and that dedicated visiting doctors or paramedics are better placed to do this work.

However, home visits do have benefits for both GPs and patients. First, leaving aside the patient element, it’s worth reflecting on why we are so stressed and at risk of burnout. It’s actually not bad for us occasionally to step away from the consulting room and go for a drive, listening to the radio, a podcast for CPD or relaxing music on the way. You might even stop at a shop and buy lunch. We can use this downtime and shouldn’t regard the journey as a chore.

Home visits also increase our awareness of our patients’ situations, helping to improve how we care for them holistically and even preventing future unnecessary appointments. I was reminded of this recently when I visited an elderly woman receiving palliative care. I got there only to learn her visit was a mistake; she had been seen the day before and should have been scheduled for review a week later. On realising this, I prickled with annoyance.

The journey needn't be a chore; we can use the downtime

But then I stopped myself. I sat down. Her cat sat on me. We chatted about how she and her cat go everywhere together, which is why she can’t move to a care home or hospice. We talked for about 10 minutes while I stroked the cat. Her daughter joined us and I explained we’d be back the following week. I didn’t particularly want to go as I was comfortable having a chat with her, and so was the cat.

Often the information we glean from visits is invaluable. The medication given the previous week that’s still in the packet; the living conditions; the supposed non-smoker’s ashtray full of cigarette ends; the other family members; the temperature, the cleanliness, the security.

I don’t regard visits as a waste of time. I try to make the most of the time away from the computer and the opportunity to speak to people in their own environment. That way we can understand their needs and help them accordingly.

Dr Justine Hall is a GP in Guildford, Surrey 

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Readers' comments (25)

  • I wholeheartedly agree with Shaba. Home visits was the final straw for me and definitely contributed to developing burnout. Having to rush around in your car in possible dangerous driving conditions perhaps not knowing the area in a finite amount of time before pm surgery would start was a recipe for disaster. And this goes without mentioning the faeces, the aggressive dogs etc etc. To even then turn up as the patient was arriving in their own car or to find the house likely empty or to then go through the stress of working out whether it was worth calling the police to bash in the door or find in general that pretty much every visit was inappropriate. Patients in the UK do not care about your time on home visits, they sees it as their right and as they are free, it is completely abused. I am so glad that I no longer do any home visits anymore and it has changed my life for the better. I am far less stressed at work and actually enjoy being a GP now. Its a shame I had to emigrate to do that though.

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  • To answer the question....YES !

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  • I feel home visit is a waste of time and it is not an efficient use of time and resources.

    In the winter just gone, my car skidded on ice because of home visit and it turns out the woman yes indeed have cancer but perfectly able to get to the surgery if she wants to but she just likes a home visit. Never mind the cost and time it takes me to get my car repaired and lost 2 years of no claim.

    In 1 of the surgery I work in people just treat home visits as an entitlement they feel the GP should make their way in grace and go into their house and sort them out. I have now increasingly make it clear to a few of them that I will put in the notes to say visits should be screened and they need to come to the surgery for an appointment.

    Completely agree with Harvey Steinwein only real patients that need a visit are terminally ill or genuine housebound patients. If a patient starts making a song and dance about it I often say well I don't see you asking the cardiologist you see from the hospital to do a home visit!!

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  • Home visit to a lady "bed-bound", then see her walk up the stairs of my practice weeks later to see the F2....

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  • Ah yes...Dr Hall works in Guildford....Surrey has the 4 of 5 least deprived ccgs in the country

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