>Quality General Practice must still include home visits to those who
>medically need them.
Laurie, I, and I'm sure most of those on GP-UK would agree with you. I
still do routine home visits. It's the fact that 99% of visits are not
necessary that I find upsetting. e.g. kids with snotty noses, little old
ladies who had a fall 5 days before, but whose daughter wants them "checked"
AND people who don't like driving at night. ;-)
Dr GM Trowell
Highbridge Medical Centre
Highbridge
Somerset TA9 3YA
01278 783220
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Highbridge - a cemetery with lights
-----Original Message-----
From: Laurence Miles <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 06 February 1998 15:39
Subject: Home visits - excuses rather than care
>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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