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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 worked in Australia as a GP for 4 years.
    Total No home visits in the period= 0.
    Balance sheet ,expressed as Net effect on Population=0.

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  • Shaba doesn't mention the biggest problem: poor access to notes during a visit. Frequently meaning a second consultation by phone when I get back to the surgery and can look through past medications etc...

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  • Shaba N is correct.
    If Dr Hall is so keen on visits, she can do them!
    They are a colossal waste of time and often undertaken in terrible weather, icy roads, snow and pitch dark - with zero consideration for the health and well-being of the GP.
    I do as few as is humanly possible.
    The only indication is genuinely housebound and terminally ill but even these are increasingly the remit of 'hospice at home' nurses and paramedics.
    With the impending salaried service and destruction of partnerships, visits will no longer be part of the GPs job.

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  • I think we’re asking the wrong question. In an ideal world where there are plenty of GPs, an allocated slot for home visits, plentiful parking, empty roads, and patients who only request them when appropriate, then yes, home visits are certainly not a waste of time.
    The reality is fewer GPs squeezing visits into their supposed “lunch break” seething in roadworks before arriving at a house with no parking (hint......the house you are looking for always has the most cars on the drive) to see a patient who could easily have made it to surgery.
    And don’t forget the joys of seeing a key-code box (for which you don’t have the code) or wandering around baffled by the bizarre numbering system on estates presumably designed by stoned hippies in the late 60s.
    No, they are not a waste of time, but simply a luxury that the threadbare Primary Care service can no longer safely provide. Most GPs already triage and scrutinise visit requests down to the bare minimum, otherwise we would implode.

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  • I so didn't want to answer this. The obvious question is who will see those who don't have relatives who can take them, don't have the benefit of ambulances to take them to the surgery ( my friend, I also worked in Australia and that is how visits were avoided apart from nursing homes and palliative care) and those who are confined to home? Hey, let's do a consultation over the Internet because everyone has that, don't they? Er.... no.
    And I am sorry that Shabi ( who I normally mostly agree with ) has her middle class sensibilities challenged but are we that removed from reality that we get upset over such things such as hygiene? Yes, there are wasters who use home visits for social reasons but they are a minority the same as child home visits ( one of whom, I reluctantly visited and then found had meningitis who would have probably died if I had argued for them to brought to surgery). I know the cool ethos of Pulse is to be angry, bitter and hateful of patients but a bit of temperance would be welcome sometimes.

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  • I so didn't want to answer this. The obvious question is who will see those who don't have relatives who can take them, don't have the benefit of ambulances to take them to the surgery ( my friend, I also worked in Australia and that is how visits were avoided apart from nursing homes and palliative care) and those who are confined to home? Hey, let's do a consultation over the Internet because everyone has that, don't they? Er.... no.
    And I am sorry that Shabi ( who I normally mostly agree with ) has her middle class sensibilities challenged but are we that removed from reality that we get upset over such things such as hygiene? Yes, there are wasters who use home visits for social reasons but they are a minority the same as child home visits ( one of whom, I reluctantly visited and then found had meningitis who would have probably died if I had argued for them to brought to surgery). I know the cool ethos of Pulse is to be angry, bitter and hateful of patients but a bit of temperance would be welcome sometimes.

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  • Rural visits can take 90 minutes. It is not time to relax. It is mega stressful because the work just waits for you. In poor driving conditions [ I have slid off icy roads ] it is a nightmare.
    Of course, it has its benefits, but we do not have the time.
    Witness Enniskillen. GPs just cannot cope and have just left. I have spoken to some of them. HVs in an elderly, aging population, especially requests from concerned relatives in London, with the threat of manslaughter charges for failure to visit, is not conducive to staying.
    I find them useful at times, no doubt, but I just do not have time.
    Some of my visits are only 10-12 miles away but the roads are so tortuous, they take for ever.

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  • Rogue1

    Just did a home visit last week, on a chap with problems in the nether regions. Turns is started on his boat that morning, so had to drive 1.5 hours home then had the gall to call me out!!!
    We've all probably got stories like that!

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  • Thought provoking.

    I think most of what I do as a GP is pointless. The majority of consultations are unecessary.

    "The art of medicine consists in amusing the patient while nature cures the disease"
    Voltaire

    I have a profound dislike of Home Visits. They are vastly time consuming and generally pointless. I triage most of them and suffer complaints as a result.

    Some Home Visits are worthwhile and important.

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  • A pay per service would sort this out pronto,there is no cost to the service user for abusing this service.If we did what the rest of the world did hopefully our time would be more valued.At the moment we are not visiting is often abused.The number of times I have been and the patient has popped out in my long career!

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