Sophie Cook: Home visits in the snow

sophieEven 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’ve 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’ve 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’t 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.  In my experience most doctors are very committed to delivering care. I’ve 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.

Provision of home visits in the snow can cause problems. If someone requests a visit and you don’t think you can reach them, what should you do? If they cannot get to you, the likelihood is that you won’t be able to reach them.  And what is the medico legal position of an on-call GP who cannot perform a visit? It’s 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’m always happy to visit patients, and I’ve 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.

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 “doctors should make every reasonable effort to visit ill patients at home, but only if it is the safe and sensible option.” Dr Jim Rodger, Head of Professional Services at MDDUS, says: “It is essentially the application of common sense rather than any legal or service requirements,” and “the general advice is to gather as much information as possible, decide on urgency, act in the patient’s best interests, and apply common sense.”

Dr Claire Macaulay, Medical Defence Union medico-legal adviser says, “It 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.”

Dr Richard Stacey, medicolegal adviser at the Medical Protection Society (MPS) says, “we advise doctors to gain full information on the patient’s 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’s best interest, whilst ensuring the doctor’s own safety.”

This does all seem like common sense, and while it’s comforting to know that we should only do what is safe, it doesn’t ease the burden of these decisions. I continue to keep my wellington boots in the car and look forward to the spring.

Sophie Cook is an assistant editor, BMJ, and a general practitioner in North London.