Tuesday, 5 June 2007

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.

5 comments:

eryn said...

Dr Brown,
Your post reminded me of an old consultant I used to have. He is now an anaesthetist and when the theatre was quiet he’d entertain me with stories of house calls as a GP in the UK. Once he had completely unknowingly gone to a brothel to see a patient. Another time, he visited a couple living in a railway cottage and sampled their famous home brewed beer; of course they both had terrible gout! Hope you keep up the home visits, sir. It shows a touch of old fashioned care.

The Shrink said...

My most memorable home visit was to see a somewhat frail and elderly lady in biventricular heart failure. it was my first time seeing her at home.

The reception staff got the notes for me, so after morning surgery off I went to see her.

Knocking on the door, getting no reply, I let myself in calling out her name and who I was, seeking her out (since she couldn't mobilise readily so couldn't open the door for me).

From the kitchen window I saw a middle aged man in the garden, he saw me in the kitchen and came over.

It transpired, instantly, I was in the wrong house - the right address according to the notes, but I'd been given the wrong address!

Remarkably the chap was incredibly understanding and curiously apologetic. Most bizarre, after wrongly entering his house, although I was mortified and pologised, he was insisting on apologising to me for my time being wasted!

Dr Andrew Brown said...

Thanks Eryn and Shrink for your entertaining stories. Dear me! All these good people leaving general practice and returning to hospital practice, leaving us here alone and palely loitering. :-)

janeway said...

Doc,
Is medicine your belle dame, then?

Dr Andrew Brown said...

Janeway: I hadn't intended to imply that, but maybe it was a Freudian slip? Hmm: medicine - can't live with her, can't live without her. :-)