I have with interest followed the debate on home visits. Almost all of the
comments have rubbished the value of routine home visits, and clearly the
comments made geuinely reflect the author's opinions - what they *want* to
believe so that they can justify this stance.
I yesterday performed a routine visit on a patient. It was two weeks late -
all our routine patients are told roughly when they will be seen, but
understand that they have to be fitted in with all the other work in the
practice. The patient is a lady in her seventies, with severe rheumatoid
arthritis, hypertension, eczema, depression, steroid-induced severe
osteoporosis, COAD, pernicious anaemia, and photosensitivity (due to
Opren). She has on a number of occasions suffered spontaneous fractures of
her vertebrae - once on coughing, and another time on turning suddenly. I
see her every 6-8 weeks. This lady requires regular review and follow up of
her many problems, and (no disrespect to any nurses) she requires medical
assessment of these problems - frequently on a consultation medication will
be changed by me. I accept that _some_ of the consultation is socially
based - but what is wrong with that? It would seem that this poor soul, who
is managing (just) to cope at home, would only be visited for urgent
problems by the majority of correspondents in the home visit debate. Put
yourself in her shoes - what would you want if you were her?
We routinely visit anyone discharged from hospital after any major problems.
The last one I visited at the weekend was a 32 year old lady, who was
admitted with a probable schizophreniform illness, and several months later
while on the psychiatric ward collapsed. She developed severe pulmonary
oedema, probably due to a viral cardiomyopathy, requiring two spells of
ventilation, and nearly died. Shortly after discharge she had coronary
angiograms, and during the procedure suffered a small dissection of one of
the coronary arteries. Since discharge she has been having chest pain,
relieved by GTN. I spent over an hour talking with her, answering her
husband's and her questions. I sorted out a problem with her medication, and
made arrangements for urgent blood tests which had been missed by the
hospital.
I could go on (and on) but I won't - unless more GPs try to give fatuous
arguments to justify their non-visiting of patients. The above two patients
needed home visits - if the last patient had been seen in surgery (which
could just about have been achieved) I could not have spent anything like
the amount of time with her that she needed. I suggest that everyone who is
justifying their non-visits takes a long hard look at all the chronically
ill in the community. Run computer searches, or even just watch for them
when the prescription requests come in. Then check when they were last
assessed by a doctor for *all* of their ongoing medical problems, and
regarding their medication.
Routine home visits *are* essential for a very small minority of patients,
just as routine follow-up of many patients with medical problems is
essential. Incidentally, we have never performed (or offered) routine home
visits to the elderly, as most of them come and see us regularly in the
surgery (or else have been out shopping or working(!) when we visited them
years ago).
Quality General Practice must still include home visits to those who
medically need them.
(Flak jacket on, and climbing into my bunker..)
Laurie Miles
GP, St Helens
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