CSA troubleshooting: 7 - Home visits

Home visit cases in the CSA are a problem area for some candidates. By Dr MeiLing Denney.

On each CSA exam circuit there is a home visit room, but this does not mean every candidate will get this as a case.

How it is covered in the CSA exam

A home visit case is there to enable you to demonstrate your ability to deal with a patient in a different context. In the home visit room, the patient will usually be in their night clothes and in bed. You will be escorted to the home visit room before the case starts, and when the buzzer sounds indicating the start of the case, you will be expected to knock on the door and enter the room.

There is no need to take any equipment from your own room with you, as this is provided in the patient's room. The case notes will also be available to you there. The examiner will already be in the home visit room with the patient and, at the end, you will be escorted back to your room by the circuit marshal.

What to do in the exam

At the start of the CSA exam you usually have five to 10 minutes to read through the case notes for the entire exam which are placed in the order in which you will see the patients. You may find it helpful to note whether any of the cases you are going to see is a home visit case.

For this case, be prepared to be escorted down the corridor to the appropriate room.

When you are doing a home visit case, remember that you do not have immediate access to certain services in the surgery, such as the ability to print out leaflets or direct the patient to reception. You will, however, be expected to be aware of the services available in the community, such as district nurses, social services and care assistants.

How to prepare

By their nature, home visit cases are likely to involve patients who are unable or unwilling to visit the surgery. They may be seriously unwell or dying, or significantly mentally or physically disabled.

Make sure you are aware of end-of-life issues, and revise your therapeutics relating to symptom control in palliative care.

You should also ensure that you are aware of the relevant teams, such as palliative care nursing teams, charitable agencies and community mental health care workers, as well as services that cater specifically for the disabled.

Familiarise yourself with such issues by attending surgery team meetings where housebound, nursing home or palliative care patients are discussed. You may also wish to visit the local hospice or an organisation that caters for chronic neurological disorders.

Learning Points
  • A home visit case will enable you to demonstrate your ability to consult with a patient away from the surgery consulting room.
  • Remember that you will not have immediate access to certain services in the surgery, or the ability to print out leaflets or direct the patient to reception
  • Be aware of the relevant teams in the community, such as palliative care nursing teams, community mental health care workers, and services that cater specifically for the disabled.
  • Dr Denney is an MRCGP examiner, and a GP in Edinburgh

Photo: iStock

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