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Just like home

Recently, on twitter, a GP posted a question to other health professionals – should we still be doing home visits?

It got me thinking and reflecting on a patient I had seen. She was in her 80s, and lived alone in a little cottage fairly far from the surgery, in the middle of the countryside. She had some memory loss, and it had been noted by previous GPs that had seen her that she could probably do with more help at home, but she had always cheerfully and adamantly refused this.

She’d been seen not long ago by another GP, with some vomiting and abdominal pain, that she wondered had some blood in it. She refused to go into hospital – she didn’t want to leave her beloved cat. She was actually well in herself at the time, – so the GP did some bloods and arranged to see her again the next day.

So I get a call from the lab at 5 o’clock – it’s always at 5 o’clock, isn’t it! – to tell me her haemoglobin was 6. My heart sinks because I know she won’t want to go in but I’m worried about her. I try to call but she doesn’t answer. She doesn’t have any family nearby at the moment. So I put on my coat and get my torch (a necessary addition to my doctor’s bag, working in the country!) and go and see her.

I walk up the muddy lane, and my shoes are filthy by the time I get there. I walk through the kitchen, automatically having a quick look round – I sometimes find the state of the kitchen is a bit of a barometer for how well someone is doing at home. She’s in bed when I arrive. She’s not looking well – she says the tummy pain has got worse over the last hour and she’s nauseous. She looks, as you might imagine, extremely pale. I see her pictures all around her bed – a sepia toned portrait of a handsome man in army uniform, plenty of her cat, and various babies that I assume are her grandchildren. Her nighties are neatly folded on her chair. Her adored cat winds around my ankles and then jumps up to join her on the bed. We talk about the blood tests, and how I think she should be in hospital. She understands, but looks scared. “What will happen to my cat? I can’t just leave…”

We talk about her worries. She says she doesn’t really want to go to hospital, she had a horrible time when she was there before she tells me. Noise all the time, overworked nurses and doctors, horrible food, needles upon needles, not sleeping, horrible smells, missing her cat. But… she hesitates… but she’s feeling pretty ill… she wouldn’t mind so long as I can sort out the cat. So I speak to the daughter, and she tells me of a local cattery that could have her while the lady is in hospital. I call for an ambulance and pack her a bag with her neatly folded nighties and books. I attempt to allay her concerns about going into hospital, but I am afraid that I can’t deny it’s probably not going to be pleasant. And I admit there will be needles involved. She relaxes a bit and settles into bed to wait for the ambulance.

So my meanderings here come to how much I actually enjoy home visits. I have always thought that they are one of the most integral parts of general practice. Of course it’s not feasible, or at all necessary, for home visits to be done for everyone – or indeed most – and there will always be some patients that expect a visit but honestly don’t need one. But for a subset of the population, it can be hugely valuable and, dare I say, a privilege.  Of course a great number of the people we need to invest the most time in – the elderly and those needing palliative care, as examples – will never be able to come to the surgery. To be able to enter people’s homes means you can see more of their lives than you ever would have done in the clean ordered atmosphere of our consulting rooms. I personally think the home visit is one of the most valuable parts of our profession and I’m grateful for the chance to continue to do them.

Dr Georgia Belam is a GP in Devon