Locating your patient

MEDICAL MATTERS: If you drive on Irish roads at weekends or evenings, you may see what appears to be a luridly coloured police car.

As you respectfully slow down you will see that "doctor" is written across the panelling and you can resume your former speed and demeanour. This is the co-op car, a newly introduced species to Irish wildlife.

It is a pleasure to see the GP lolling nonchalantly in the passenger seat, enjoying the countryside while the driver worries about the destination. In the old days when doctors drove themselves, an inordinate amount of concentration and energy was spent in getting to and from house calls.

This was particularly true for newly arrived doctors, locums and those whose rotas covered areas other than their own. In fact, the medical problem was usually a dawdle compared with finding the house.

Finding a Murphy in a bungalow in west Cork on a rainy night is far more difficult than treating a simple chest infection. But as the GP blunders up and down the boreens, as the call that should have taken half an hour has already taken an hour and you still can't find the bloody place and there's no one to ask, imagination takes over.

The simple chest infection has probably deteriorated dramatically and will require emergency treatment with equipment you didn't bring and the family will sue and God knows what awful case will be waiting for you when you get home. I have often felt in need of some medical attention myself by the time I have found the right house.

It is a sad fact that most people can't give directions. Sometimes they don't want to. In the context of a family illness, the person making the phone call cannot understand why the doctor is worried about piffling details like is it the third or fourth turn to the left. Surely such things should be self- evident. I have been often tempted, but never dared, to assume a foreign accent on the phone just to obtain detailed instructions. Even if I did, it might not make any difference. Guidance like "turn at the house where Mrs Riordan used to live and cross where Jack crashed the car" is not unusual.

Once, years ago, in the rural west, when asked for a house call, I asked how I would recognise the house. After a pause the information was volunteered that it had a white gate. I drove around that area for at least an hour before I asked for directions at what turned out to be the house I sought. The gate, on close inspection, may have been painted white to celebrate the foundation of the State and not touched since. What I had not been told was that there was a four-storey ruined castle keep in the back garden of this house which was visible for miles around. They said they were so used to it that they didn't notice it any more.

There are regional variations in directions. In Donegal, where I had the good fortune to work for many years, directions are given in Scottish. "Up yon brae and past the corrie. Aye, it's a brave way." Fortunately I had read Maurice Walsh in my youth and so understood the terminology. In fact, I would recommend his novels to anyone on the Donegal general practice training scheme.

During The Troubles in Northern Ireland I spent an inordinate amount of time on call driving around housing estates at night. It was always difficult to find particular houses as all the numbers had been removed, presumably to confuse the security forces. I could usually tell the prevailing religion from the colours of the paving stones which was a great help. I could have done with the benign presence of a driver in those days... A doctor in the field feels much safer in today's co-ops.

The first real innovation in out-of-hours calls in my working lifetime was the mobile phone. The first mobile I used was about the size and weight of a concrete block. It was so heavy that when I left it on the roof of my car by accident it was still there after a two-mile journey. Which was just as well as it had cost about three times as much as the car.

The phone worked in relatively few parts of the country and its battery lasted for about an hour. It did, however, give a measure of freedom and the anxiety about what was going on back at the ranch was hugely diminished.

Nowadays, you can go for a walk or mow the lawn while on call. You can even ring the patient for further directions when lost. But for true peace of mind give me a car in the Brazilian colours with a benign ex-policeman driving and I will leave getting lost to my spare time.

Dr Pat Harrold is a General Practioner in Nenagh Co Tipperary.

Dr Muiris Houston is on leave.