{"id":24029,"date":"2013-01-24T17:45:27","date_gmt":"2013-01-24T16:45:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=24029"},"modified":"2013-01-24T17:45:27","modified_gmt":"2013-01-24T16:45:27","slug":"sophie-cook-home-visits-in-the-snow","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2013\/01\/24\/sophie-cook-home-visits-in-the-snow\/","title":{"rendered":"Sophie Cook: Home visits in the snow"},"content":{"rendered":"

\"sophie\"<\/a>Even in the most auspicious weather conditions, urgent home visits are time consuming and on days when snow falls this creates another obstacle to negotiate in an already stressful on-call day.<\/p>\n

I\u2019ve become irrationally fearful of the snow. Children love it, but adults tend to be less welcoming of snow due to the disruption to day to day life we\u2019ve come to expect from it. Even in central London snow has the potential to grind transport to a halt and in more rural locations this disruption is ever more severe. Remote working isn\u2019t an option for healthcare providers in a way it might be for other professions when weather conditions are bad. People still fall ill and need assessment and treatment, and asking them to wait until the weather improves is not an option.\u00a0 In my experience most doctors are very committed to delivering care. I\u2019ve known colleagues take extreme measures to get into work, some even walking for miles in the snow to avoid letting colleagues down and disrupting service. <\/p>\n

Provision of home visits in the snow can cause problems. If someone requests a visit and you don\u2019t think you can reach them, what should you do? If they cannot get to you, the likelihood is that you won\u2019t be able to reach them.\u00a0 And what is the medico legal position of an on-call GP who cannot perform a visit? It\u2019s an interesting dilemma, but yet another problem to consider when you already have a surgery full of extras and several visit requests to triage. Decisions will probably depend on your local practice protocol (if you are organised enough to have one). You might be lucky enough to have a colleague with a 4 wheel drive car who is more equipped to take on visits in the snow. But ownership of a 4 wheel drive car is not a requirement to become a GP, and you might not have this luxury. For a single handed GP this situation is even more difficult as there is nobody to share this burden and decision with. I\u2019m always happy to visit patients, and I\u2019ve never declined a visit if someone feels it necessary, but in poor driving conditions, one has to consider the risk of getting stuck in the snow and the further disruption to service this might cause if the on-call doctor is stranded and out of action.<\/p>\n

The MDDUS issued a press release this week regarding how to deal with home visits in the snow following a number of calls from GPs for advice on this matter. The MDDUS says \u201cdoctors should make every reasonable effort to visit ill patients at home, but only if it is the safe and sensible option.\u201d Dr Jim Rodger, Head of Professional Services at MDDUS, says: \u201cIt is essentially the application of common sense rather than any legal or service requirements,\u201d and \u201cthe general advice is to gather as much information as possible, decide on urgency, act in the patient\u2019s best interests, and apply common sense.\u201d<\/p>\n

Dr Claire Macaulay, Medical Defence Union medico-legal adviser says, \u201cIt is important that each patient is offered an appropriate consultation which may be at the surgery. It may be necessary to offer some patients a home visit if it is not possible for them to safely make their way to the surgery, for example, if their mobility is poor, and every effort should be made to reach them safely.\u201d<\/p>\n

Dr Richard Stacey, medicolegal adviser at the Medical Protection Society (MPS) says, \u201cwe advise doctors to gain full information on the patient\u2019s symptoms, past history, and the weather conditions in their area before making a clinical decision on how to proceed. Any decision should be in the patient\u2019s best interest, whilst ensuring the doctor\u2019s own safety.\u201d<\/p>\n

This does all seem like common sense, and while it\u2019s comforting to know that we should only do what is safe, it doesn\u2019t ease the burden of these decisions. I continue to keep my wellington boots in the car and look forward to the spring.<\/p>\n

Sophie Cook<\/strong> is an assistant editor, BMJ, and a general practitioner in North London.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Even in the most auspicious weather conditions, urgent home visits are time consuming and on days when snow falls this creates another obstacle to negotiate in an already stressful on-call day. I\u2019ve become irrationally fearful of the snow. Children love it, but adults tend to be less welcoming of snow due to the disruption to […]<\/p>\n

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