Visits

The number of home visits done by GPs in England has fallen dramatically over the past few years. When I started two decades ago I would regularly do between two and four every day, nowadays I average one a day or less. The number of “late” or emergency visits has also fallen as patients become used to attending surgery for almost everything. Unusually today my working day both began and ended with a visit.

A few patients who are also friends have my home telephone number and do not abuse the privilege. As I was getting up this morning I was rung by the wife of an old friend and agreed to call in on my way to work. He was suffering badly from vertigo and matters were complicated by the fact that they were due to drive to Heathrow later today to go on holiday. My friend, though bed-bound, was still keen to go. His wife shook her head with a rueful smile.

Normally in a case of recent onset vertigo for the first time with no hearing loss, I would suspect viral labyrinthitis (a transient infection of the balance mechanism of the ear). However my friend had recently started taking allopurinol, and vertigo is a rare side effect of this drug. There is an interesting statistical paradox here. Since vertigo is an extremely common symptom of viral labyrinthitis and a rare complication of allopurinol treatment, you might imagine that when someone develops vertigo they are more likely to have labyrinthitis. But when that person is already taking allopurinol it is more likely that they have developed a rare side effect of the drug than that they have developed an unrelated disease where vertigo is common. There was also some corroborative evidence: he had not had a recent cold (which commonly precedes labyrinthitis) and his symptoms, which had been coming on for a few days, were worse after he took his daily tablet. In any case the treatment is the same, and I prescribed an antihistamine. He will also stop the allopurinol, of course. If the vertigo is due to allopurinol then it should clear up very quickly, labyrinthitis takes a week or two to settle. That will help to confirm the diagnosis when I next see him. I didn't try to adjudicate on whether they should go on holiday!

During evening surgery I was asked to visit an elderly lady. By the time I rang her back she was feeling better and was mobile once more, so there was no reason for her not to be brought to the surgery. But old habits die hard and I reckoned it was almost as easy for me to pop in to see her on my way home. The gods were clearly smiling on me for I found a residents parking space directly outside her home (and no parking ticket on my car when I emerged), and she lived with her able bodied son. This meant that he could go to the late night pharmacy to obtain the antibiotic that I prescribed, and also take her urine sample (taken before the antibiotic was started, of course) to the surgery first thing next morning. But the gods are not always so kind, and we will continue to encourage patients to see us in surgery unless they are immobile.