to stay home rather than trekking across the city with DS3 to see a doctor? (Long)

[BoffinMum]

DS3 (age 3) has a kiddie virus, all the usual symptoms, but with the slightly concerning addition of ice cold feet, so I looked on NHS Direct for advice. He does not have a headache and he can look at light, so I wasn't hugely worried, but I thought I ought to take it reasonably seriously, considering the cold feet thing. NHS Direct advised me to ring my GP, which I did. I have been instructed by the Out Of Hours service to trek across the city with my very sleepy, poorly DS3 to get him looked at, which also incidentally means taking two other children with me (one of whom is knackered and may be going down with something himself) and causing a great faff. I am knackered too, and my SPD is bad today. And they told me that 'illness is dynamic, so even if the GP thinks he is OK during the appointment, you will need to keep him under close observation'.

Here's the thing. I actually want a home visit for once. I don't want to trek across the city in pain, with DS3 in pyjamas and a blankie, and sit around in some remote suburb until some doctor deigns to see me, patronise me and probably just send me to sit at A and E all night anyway, after being triaged by about five nurses, all of whom ask us the same things, before we are sent home at 3am feeling like complete idiots and slight abusers of the NHS.

I know all the arguments about how inefficient home visits are, how greedy we all are for wanting them, how terribly BUSY and IMPORTANT doctors are and how they can't be expected to pander to the social needs of their patients, with all they have to do, and, most crucially, how feckless people demand home visits because they have coughs or hangovers, and ring for ambulances because they have run out of Tampax or whatever. I really do know all that.

But just today, I would really, really like someone to come to have a look at DS3 in his home, in the context of his family, and tell me how worried I ought to be.

That's all. Just one of the six or eight doctors from the local practice to pop up the road and do a bit of a Doctor Finlay.

AIBU?

It was a bad call - I accept that. I also think the NHS should be doing more for you and the rest of the population for that matter. We are, however, where we are and if the lad needs looking at he needs looking at. If you have four you are obviously a very experienced mum and "know" a good call from a bad call just as the hcp's manning phone lines give advice to minimise litigious risk. I hope you are OK and that little one is OK. I would want my mind put at call.

If I had felt I would cause an accident, I wouldn't have done it - at least not without an automatic - but you are right it was a risky call.

Good news, DH is home, we've had a chat and we are going to wait and see. DH said he would take him up there straight away if I thought he needed it, I said I think we should give it an hour or two, not least because I think DH is too tired to drive at the moment (he has been working very long hours this week).

Bus, Noquontrol? There aren't any buses around here at this time of the day!

I am actually disabled - I've got osteoarthritis and SPD. I can walk well some days, but today is not one of them.

Right, just checked him again. Temp has gone down to 100.3F and his feet are the same temp as the rest of him now. Still no rash.

Feel quite relieved.

If you NEED a home visit, then a hime visit is what you should have. If you just don't want to be botheered with the hassle, then frankly... tough.
I reckon most people know the difference.
SPD and osteoarthritis, lots of kids, 2 of whom are unwell... I reckon you would've been right o insist on home visit.

There is limited GP cover OOH. Home visiting should be for the elderly, terminally ill and immobile. The service would grind to a halt if lots of people demanded home visits when they are not needed.

Children are best assessed in a clinical setting, rather than in the home anyway.

YABU-especially as your DH can drive him over if needed.

I do hope he gets well soon though.

Cold feet in a small kid isn't a big deal. Kids often get peripheral vasoconstriction when unwell. Getting him to OOH sounds inconvenient, but being inconveient isn't a reason for a home visit, home visits are for people you can't get out of the house, usually frail elderly people. Children are portable.

home visits should be for immobile and terminally ill and elderly, what if that immobile, elderly or terminally ill person has dependants that need seeing? i f it was a visit for them then the dr would come but if it is for their dependants they shouldnt?

where I live the doctors will do a very limited number of home visits e.g. to elderly patients in normal working hours. All out of hours care is contracted out to a centralised private company. heaven knows where they find those doctors but I wasn't impressed - his diagnosis was utterly wrong. Luckily for us just something that had to run its course but I will never forget what a misery it was compared to being ill in childhood, when you (and more importantly your parents who were worrying madly) always knew which GP's night it was and who they were, and they you. There are also the terrible examples of negligent care e.g. the GP who came overnight from Germany speaking little English and killed an old man with an overdose as his English was poor.

Sorry boffin mum, I just assumed there were. Don't know where you are so that was a bit of an assumption. How would you have got there then if you needed to go?

What you have said certainly doesn't sound like it warrants a home visit especially not now he is thankfully more settled.

The problem with home visits is that it vastly reduces the number of patients that can be seen in the time frame. For most people it makes much more sense for them to get to the dr and be able to be seen than to hope to get a GP out at some point in the night when he is only about to do 2 visits an hour if he is lucky.

Comptoir, the OOH centre that successfully killed the old man through their incompetence is exactly the one where I was supposed to be going tonight with DS3. This is also a factor in me not being convinced it is worth going.

Sirzy, I know all that, but what I was saying was that I missed being able to have a local GP call by for the reasons I specified.

I totally agree with figwit and 2rebecca. An average GP has 2000 patients, and that's during the day at full staff capacity. Out of hours the ratio of patients to doctors is far far greater. No one wants to leave their warm comfy home when they feel ill, especially not if it involves taking other children too. But this is a limited service, it's state funded and cuts are being made all the time. The "good old days" when doctors popped round at the drop of a hat can't be compared to now. Medicine is totally different, the role of the doctor is different, expectations and outcomes are different, it's a different world.

And trust me, the days of your own GP visiting at all hours weren't so great. We did nights on call then worked all the next day, so we were exhausted. Would you really want to be seen by a doctor who'd been awake for much of the previous 30+ hours?

I hope your DS gets better quickly and you all get some sleep.

And if you consider the numbers. If just 1% of my patient population were ill this evening and wanted me to "pop round", that would be 20 visits. Over an average patient area that could take half an hour plus just driving between visits. Then add on the time to actually see the patient. That's most of the day gone. And what about all the people at the surgery waiting to see me? And the admin?

YABU.

Hope he feels better soon.

Tough call when you're struggling with mobility and you have other little ones too.

As for home visits, I think you'd be hard pushed ESP out of hours.meven in hours and with obvious pneumonia symptom, in deep snow and no one else at home I didn't get one. Had to wait il I could get a lift to gps, then a lift to hospital straight after gps.

One of my dc always gets very cold feet with any temperature, the doctor has never been particularly worried by it. Dd2 has no hand on one side and with a temperature her little arm goes completely blue, alarming the first time it happened, but no sign of anything other than a temperature.

Ime out of hours/nhs direct tend to ask you to see a doctor with that sort of thing. Generally symptoms like you describe I would feel confident that I needed do no more than watch and give pain killers.

I have had a home visit, but that was at the GP's suggestion not my request, he was concerned about ds from an earlier visit and he phoned to ask how he was, and when I said no change popped in on the way back from the surgery.

The problem is if you say you'll get home visits because you've no babysitters then you'll find a lot of people have "no babysitters". Like when the AA said they gave priority to single ladies on their own, they discovered a high proportion of calls by "single ladies" when they arrived they found the passenger(s) sitting round the corner.

Velmadaphne - so for the area in which you work, does anyone get a home visit out of hours now? And who is deemed to merit one in the day?

Just to say about the ambulance idea - consider the difficulty of getting to A&E, parking, carrying/pushing children etc before rejecting an offer from NHS Direct to send one to you.

I didn't, and even though I was strongly advised to get ds to A&E quickly, thought it was overkill to have an ambulance as we're only a 10min drive from the hospital and it was not an immediate emergency (things had calmed down - temporarily as it turned out).

In the event, driving to A&E was no problem at all. Finding somewhere to park anywhere near the entrance took another 10mins. Unloading 2 children, one slipping back into near unconsciousness, pushing the pram about half a mile across the car-park only to find you have to go the long way round to get to the A&E entrance (up a small hill) was another 10mins. When I got to A&E I could barely speak! Then, as NHSDirect has no liaison with the hospital, they obviously thought I was over-reacting, despite repeating several times exactly what the triage nurse on NHSD had said and when we were eventually able to leave, the letter didn't accurately describe the reasons we were sent in" in the first place. I am still cross about it. You might be able to tell.

Next time, sod the cost to the tax-payer - I'm accepting the ambulance.

Eighties - visits are done for elderly and housebound people, people who are literally unable to make the short distance from front door to car door.

Convenience, transport, care of other dependents, patient preference are not factors that are considered.

With an ever increasing elderly population, and the move to "care in the community" rather that residential placements, the demand is simply too great to extend visiting beyond those defined categories.

YABU.

It is very difficult and can be dangerous to examine patients in the poor lighting and soft beds of home.

Home visits should only be for palliative care of bedbound patients.

It also means that a doctor takes, say, an hour seeing one patient, when they could be seeing six, meaning that other patients suffer.

Thought I would update everyone - DS's feet remained warm and pink, and he didn't develop any other symptoms, so we didn't go to the OOH surgery in the end. He is still poorly today, but it really is just a normal kiddie virus, so I am not worried today.

In response to all the GPs arguing that they are too busy to do house calls, and that it's too draining - my father was an electrical engineer before he retired, and he earned a lot less than a doctor. He was regularly required to be on call, and had to trek around in the middle of the night, humping heavy switchgear across fields in the snow, and arranging the repair of substations large and small, in order to ensure that everyone had a high reliability electricity service, 24 hours a day. So if Mrs X phones up at 3am and complains she can't listen to the World Service, even if the rest of the village is tucked up in bed, and there's no factory or hospital or dialysis patient nearby with an essential need for power, people like my dad still get up out of their nice warm beds and give up a night's sleep in order to get it all fixed up, whether they are tired or not, and whether it is reasonable that Mrs X wants her radio on or not. Engineers like my father are required to care whether the contents of people's freezers defrost, or whether a whole suburb will need its DVD recorders reprogramming. They do not pass judgement on whether it is right that someone wants to use the service, keep their freezer contents intact, or wish their DVD recorders to work. In the dark of the night, there are still electrical engineers and their linesmen teams working their arses off doing this, unsung and unobserved. Because that's the culture of the organisation.

I would argue that this constitutes a high reliability service. However I would say that for me, at any rate, the NHS no longer constitutes a high reliability service. I feel judged and patronised using it, I have no status as an individual user, and my needs are long lost amongst all the statistics and paperwork. I am sure a lot of people in my situation feel like that these days.

My dad has had weekend home visits before when he has a relapse of his very rare condition. He is unable to walk and gets very poorly, very quickly.

Last time I waited six hours for the dr to come. Not complaining about the wait they were obviously very busy. So I suppose they do have to prioritise.

I am so pleased he's OK.

About everything else you have written - bows. I think there's a MNet etiquette for this but I don't know the right keys.

bows

marriedinwhite

The nhs is for patients and I think pretty much all doctors would agree with that.
The problem is that, although we are all paying customers in that we pay taxes, the nhs is already hugely expensive to run. If you want home visits which aren't absolutely essential to be offered either we have to pay more and have higher taxes or we have to reduce costs somewhere else. Healthcare is much, much more costly than it was when the nhs was set up - preventative medicine has taken off hugely, much more effective and costly drugs are available, more expensive interventions are available. And demand is much higher than it used to be. These things all mean that the nhs cannot function the way it used to, and choices need to be made about what services are offered.
Personally, I would prefer us to continue funding, for example, expensive drugs which improve quality of life for patients with severe, difficult to treat arthritis, than to offer home visits which can be avoided.