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Medico-legal - When a home visit is necessary

The surgery is often best for patient care, but some home visits are crucial.

The most important factor to consider when contemplating a home visit is determining its urgency (Photo:SPL)
The most important factor to consider when contemplating a home visit is determining its urgency (Photo:SPL)

GPs can occasionally find it hard to judge whether a patient should be seen at home. Ultimately, though, the care of the patient is your first concern and you should always be able to justify your decisions.

The foremost factor to consider when a patient requests a home visit is determining the urgency. Weigh up the symptoms and consider the patient's previous health before deciding whether a delay in treatment would result in worsening symptoms.

Multiple health issues
For example, a patient with multiple health issues may not be able to wait until surgery opening time, or a distressed mother may be concerned about the symptoms of her young child (see the case study below).

All of the circumstances should be carefully considered. It is important not to be dismissive or make assumptions about any patient seeking help - even someone who frequently requests home visits for minor complaints.

You may have to visit a patient if they are confined to their home due to illness or disability, when urgent treatment needs to be administered or if an elderly patient is very frail.

Regardless of the situation's severity, communicating effectively with the patient is crucial and will reassure them.

Ensure you clearly understand your patient: listen to their views, respond to their concerns and take comprehensive notes.

Whether or not you decide on a home visit, devise a management plan which the patient can clearly understand, and ensure there is a 'safety net' so the patient or carer is clear about what to do if a condition does not improve or deteriorates.

Home visits can be time-consuming and problematic, especially for locums or out-of-hours GPs. They may not know the patient or have access to all of their medical records. But if you consider each case carefully, patients can continue to receive the best possible care whether at home or at the surgery.

  • Dr Gibson-Smith is medical adviser with medical defence organisation MDDUS, www.mddus.com
CASE STUDY: CHILD WITH HIGH TEMPERATURE

Missed meningitis
Dr G is a locum GP doing a session for an out-of-hours service. She takes a call in the early hours of the morning from a mother with a sick child. Mrs P's two-year-old daughter Sara has woken up vomiting and with a high temperature.

Dr G asks if Sara has any rashes or neck stiffness and when Mrs P says no, the GP suggests that Sara is likely to be suffering from a tummy bug. She advises Mrs P to put her in a lukewarm bath to bring down her temperature and give her children's paracetamol.

Dr G also discusses the possibility of meningitis with Mrs P and the significant symptoms to look for. She advises Mrs P to phone back if Sara's condition worsens or if she has any worries. She adds that Mrs P should take Sara to her own GP's surgery in the morning if the symptoms have not improved.

In the morning, Sara is still sick with a high temperature and Mrs P notices a large purple mark on Sara's leg. Mrs P calls an ambulance immediately. Sara is transported to hospital and diagnosed with bacterial meningitis. She is kept in an induced coma for five days before making a full recovery.

A few weeks later, the out-of-hours service receives a letter of complaint from Mrs P.

Analysis and outcome
In the letter Mrs P states that had the doctor made a home visit, Sara's condition would have been diagnosed and treated sooner.

Dr G contacts MDDUS, rightly concerned that the matter could escalate into a claim of negligence. MDDUS advises Dr G on her written reply to Mrs P.

In her letter Dr G expresses her regret at the suffering Sara endured. She then explains that meningitis is a relatively rare illness and difficult to diagnose, especially in the early stages when there may be no distinctive features present.

Vomiting, high temperature and listlessness are common symptoms and in most cases, due to viral gastroenteritis.

Dr G further writes that had she any doubt that Sara's symptoms were indicative of meningitis she would have visited her immediately. After a subsequent meeting with Mrs P the matter goes no further.



CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Reflect on the last five home visits you have made, including reviewing your notes about them.

Do likewise with the last five requests for visits that you declined.

  • Were you happy at the time that you made the right decisions and are you still happy after reading this article?
  • Note any reservations as learning points. Resolve to judge visits requests in a more measured way from now on. If not making a visit resulted in a 'near miss', carry out a significant event audit.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd

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