Dr Ramsha Zaheer (IMT3)  -  20 November 2025

I completed acute care at home rotation over two months in early 2025. I was both excited and a bit apprehensive about it. I was looking forward to not only sometime away from the sterile hospital environment (both in terms of the location and emotion), but as I have a curious nature, I was interested in observing what the patient’s lives were like at home. Little did I know how much it would impact my career going forward.  

Still in my early years of driving in a new country, I can tell you driving in the country lanes in the winter was no fun. The blinding reflection from the sun, navigating narrow country lanes praying a tractor won’t come from the opposite direction, Google maps giving up in the middle of the field and therefore navigating old-school style, gaining the courage to ask passers-by if I’m in the right place were some of the non-medical skills I acquired.  

Once I stepped through the front door, it was another story all together. While I was eager to improve my diagnostic skills without the support of the laboratory and radiology investigations, and contrary to that simultaneously get an opportunity to practice a bit of point of care ultrasound, I was surprised at the unintended but very valuable lessons I learned. Seeing patients in their environment and picking up clues that may have an impact on their lives, such as furniture placement that could increase falls risks, reviewing their medicine cupboard in the kitchen (with their consent of course) and seeing the pharmacological burden, notice the carer stress and then being part of the wider MDT discussions back in the hub where other members of the team have picked up different clues went on to improve my clerking on the acute medical take once I returned to the hospital rotations. 

The learning about palliative care provision could not be underestimated. Those two months were so ingrained in me, that now even on routine ward reviews in other rotations, I now pre-empt palliative care discussions. It is just about knowing the fact the wider MDT, both in the hospital and then in the community including GPs, OT and PT can work together to create the most comfortable possible environment at home to allow the patient to have a dignified death. Knowing what I have witnessed, I now find it easier to answer patients and their families’ questions when planning this. 

I remember seeing a patient, who was likely approaching end of life, but the patient and the family had not likely realised that at that point. I recall having that discussion with them – same rehearsed phrases and speeches I had given so many times in the sterile environment of the hospital. However, in the living room it hit me differently. This was one of the most important discussions a patient and their family members could ever have, in their private space, in their living room, surrounded by pictures, memories and warmth, in a home which was clearly built out of love. On top of that, the patient’s toddler grandchild kept checking in to make sure the grandparent would be ok and asked me if they would get better soon. I have had some intense family discussions back in the hospital, but nothing prepares you for the questioning by a toddler. Just reviewing the patient in their environment reminded me that we need to keep in mind that patients have lives and families outside of the hospital who care and worry for them, that they are not just a hospital or a room number.  

Acute care at home has been the most rewarding rotation of my internal medicine years. It reminded me why I became a doctor in the first place, which was something I had forgotten about in the rush of today’s fast-paced world – to help others, decrease a person’s suffering and make a difference in their lives. And for that, I am grateful for the patients who allowed me the privilege of doing just that in their own home.