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Follow up, and follow up, and follow up

My heart skipped a suspicious beat when reading the headline that hospitals (healthcare systems) are being encouraged (required) to cut ‘low value outpatient appointments’.

Maybe I had no real cause for worry – the full article reviews some initiatives which are saving time, money and expertise, by applying sensible techniques to reduce waste – such as adopting the same scheme as is used by supermarkets to identify stock of medication which is about to become out of date. From pharmacy apps to cutting low value appointments: how hospitals are becoming more sustainable | The BMJ

But the initiative to reduce frequency of follow up for patients with HIV comes nearer to the bone. From my early experience in caring for older people with dementia or other mental disorders I have carried wise words from Tom Arie – ‘stay with them to death and beyond’, or words to that effect. And from Felix Post: ‘Follow them up and follow them up. Discharge may leave people feeling they have to cope for themselves from now on – and they may not want to disappoint you by coming back if they are relapsing’ – or words to that effect.

So we did, usually by home visits – in South Manchester, in Wolverhampton, in Tameside and Glossop and in Gnosall. Tameside and Glossop was a bit of a struggle as the established regime I joined part time after ‘retirement’ (2006) was minimalist and not keen to allow my ‘old fashioned’ way of doing things. Did they not know that we created the services for older people with just this approach from the 1970s? Ground breaking and leading to an international renaissance. Gnosall was a bit different as we were working in General Practice. Much of our work took advantage of the recognition of the Practice as a sort of home by many families – and there was extra strength from the knowledge tied up in the Practice – but even there we went out to see people at home.

The combination of clinic-based contacts and home visits is powerful and effective. Attendance was all-but 100% - in contrast to the clinic-based Out Patient work of colleagues with General Psychiatry. We now have the possibility of contact via computer and Teams or Zoom – time and travel efficient, but offering only a managed window of communication – and lacking the chance to see the house, the garden, the surrounding roads, shops and other facilities. Home visits, repeated and repeated lead to being recognised as ‘local’ – and really interested in the individual and family. And you egin to feel at home too.

So I hope the drive for efficiency takes such measures into account, and that real clinicians hold their ground


Each week we post a blog from David Jolley where he shares his personal views on relevant subjects.

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