Medical Matters:The house call is, like the corncrake or the consultant's pay packet, an endangered species, writes Dr Pat Harrold.
When I started in general practice a house call was all part of the day's work. In fact, there were routine house calls. These were to people, usually elderly, who received a monthly visit.
Being young and energetic, I quite enjoyed getting out and about. At least you became aware of the time of the year, and you got a bit of fresh air opening gates, dodging sheepdogs and walking about the farm buildings looking for the patient.
I often discovered the person who was supposedly too sick to come to the surgery waving at me from several fields away as they saw to the cattle. I didn't mind, I had wellies in the boot, my dog on the passenger seat and Gay Byrne on the radio.
Mobile phones were unheard of, so you had a respite from all worries for an hour or so, even if the jobs were stacking up at home.
I always felt that the house call gave you a perspective on your patients' lives that you would not otherwise get. You found out who was related, who the neighbours were and you got a look at the house. A dapper pensioner could come from a wretched hovel and someone who looked like they lived in a ditch could hail from a mansion.
You could find a cardboard box containing the past six months' supply of tablets, which would explain why they weren't having much effect. You could gaze thoughtfully into a bog, admiring the mighty strength of a man footing turf in the sunshine and reflect on how you had given him a sick cert that morning from his job as a teacher because he had told you that his back was too bad to stand in front of a class.
As the years passed I began to slowly realise that not all calls were strictly necessary. For instance, if you referred one of the regulars from your monthly visits to the outpatients department in the hospital they would make their way there with ease.
They would also make it to the shop, the pub, bingo, wakes, Mass and football matches. In fact, the only regular callers to the house were the doctor and the man selling frozen fish. I clearly remember one of my regular calls insisting that I come out immediately, as he was going to America in the morning.
Of course, the danger of house calls was that you had not the same resources as you would have back at the ranch. For instance, you could run out of headed notepaper and find that you had to send the patient to hospital. I have seen admission notes written on pages torn from a child's copy book or on the back of half a Christmas card.
There is the story of an old-time GP who arrived at a house and realised he had forgotten his stethoscope. The patient had already pulled up his shirt and turned around, so the doctor pressed a half-crown coin up and down his back in the approved fashion and pronounced him sound. Nobody noticed.
In fact, in the old days of the dispensary doctor, the house call consisted of most of the work. One old chap, in living memory, used to start his house calls at about 7pm. He was fond, as they say, of a drop and at every house he went to he would be duly offered a drink by the inhabitants.
If they did, said my informant, they offered it to the right man. As the evening progressed he would get progressively drunker, finally landing home about midnight, having done his work and filled himself up full of free drink in the process. It is true that he used to have to wake up some of his patients to see them, but you can't have everything.
There are some rules for the home visit. Never do them after lunch. Suddenly someone will ask you to drop in on your "evening rounds". Rounds, let's face it, are for barmen, not GPs.
Always turn the car for a quick getaway, especially as some of the supposedly bed-ridden patients will accompany you to the window of the car to emphasise how bad they are. Never, if you are as forgetful as me, accept a gift of fish on a Friday, especially if you are going away for the weekend by train - not if you intend to use the car on Monday, anyway.
The appointment system killed the house call. The elderly person is now spared the interminable delay in the waiting room.They can be checked over in a well-lit area with loads of diagnostic tools.
A doctor can see six people in the time it took for one house call. Yet when the days get long, the experienced GP feels the tug of the open road, and when a nice long house call comes in volunteers: "I'll take that."
Pat Harrold is a GP in Co Tipperary.