Doctor in the house – a very valuable service

I knocked on the back door and walked into the kitchen with a flu vaccine in hand. The lady of the house turned and looked at me and then asked in a most amused voice “Noreen, are you in the wrong house?” I stared at her, sighed deeply and then we both burst out laughing as I admitted that yes, I was in fact in the wrong house. I apologised and turned to leave. She spotted the flu vaccine in my hand and said “Oh that reminds me, I must book in to the clinic to get my own flu jab”. “Sure, have this one, I’ve more in the car” I invited. “Well that would be great, if you’re sure you don’t mind. Saves me a trip to the clinic!” I happily obliged and administered the vaccine. 

We chatted for a bit and then she advised that I’d better get myself over to Mary’s next door as she would have spotted my car by now and would be wondering what I was doing here instead of at her house administering the flu vaccine to her elderly mother as planned. I headed to the correct house and another vaccine administered I headed off to continue the house calls. 

I can only blame my little lapse on an early start and a long day. One of the teens had a school trip that entailed Mom waking her at six o’clock to “get ready” for the bus at seven. Teen duly delivered to school, it was almost time to get up for real. I made the most of a quiet half hour though to complete a report as the remainder of the brood slowly awoke and began to get ready for school. 

The clinic was extraordinarily busy, then the house calls started to mount up. Driving to the wrong house earlier, I had pondered the previous call. An elderly man with a multitude of problems had a viral illness and a high temperature. He declined paracetamol in a way that many do until seen by the doctor. There were family visiting from abroad and as often happens when they have not seen their elderly parents for some time, they get most concerned just before they leave and wonder what I am going to do about Mum or Dad when they are gone, as the departing family members believe the parents cannot possibly cope on their own anymore. 

The family must be handled with sensitivity, but it can be difficult to get it across to some that these are in fact their parents and they, as family members, must be involved in the forward planning of care. Many seem to genuinely expect the GP to sort everything out, and there is a sense of very apparent annoyance at times when we gently explain that we cannot do it alone. “Can you not get him/her into the nursing home? Sure, it’s only down the road”. Explanations then ensue regarding booking respite care in advance, entitlements, Fair Deal and applications for long-term care. After detailing the facts, I often get the comment “but doctor, I’m going home tomorrow, can you not fill those forms in? Can you not sort this out?” 

Another house call was similar in that an elderly man recovering from a recent illness had a combination of impatience regarding his recovery, and well meaning neighbours who felt a little more time to recover was not an option and he should be hospitalised immediately. Again, sensitive discussion and reassurance were called for, and I spotted the same gentleman doing his shopping a couple of days later.

Arriving home after 8pm, I had clocked up over 50km along narrow twisty roads but the night was not over yet. Shortly before 5am I was called out to an elderly lady who had fallen and fractured her arm and hip. I rushed to one of the furthest locations from me. Analgesia, comfort and a long wait for the ambulance followed and it was half past six when I crept quietly back into the house. 

I was debating the wisdom of going back to bed for less than an hour when I received another request for a house-call, this time to a gentleman with severe renal colic. As I managed him, my morning alarm went off and I laughed that it was time to get up. I headed home to rouse the rest of the family and organise breakfast before heading back for the day’s clinic.

House calls are a time-consuming but vital part of general practice. Of the seven I made that day, I sent two patients to hospital. They were necessary referrals and both were admitted. Had I not done all of those calls, a further three patients would certainly have ended up in the emergency department, causing further stress on an already overstretched service and unnecessary anxiety to the patients too.

The politicians need to listen to us, acknowledge the importance of the hours and miles we spend on the roads of rural Ireland and have the decency to reinstate the much needed resources to keep this vital show on the road?