General practice has changed a lot recently, and not all of it is for the better.

I'm particularly concerned by the steep fall in home visits. Pressures of time have made it essential for anyone who can do so to come into the surgery, rather than have a home visit.

City doctors can see five, and country doctors seven people in a surgery in the time it takes to make one home visit. Far more people can be seen in a day if people can make the effort to come to the surgery.

That's logical, but it isn't necessarily as efficient as it seems, because doctors can pick up a lot about their patients in a home visit that they can't in the clinical atmosphere of the surgery. And that can be crucial to making the diagnosis or to choosing the most effective treatments.

For example, we can tell a lot about whether people are coping by just looking around the house. Is it reasonably tidy and clean? Are there tensions between people in the house?

Full ashtrays and empty bottles around the place are more truthful about the person's habits than what may be said in the surgery. And then there are the discarded medicine bottles and packs.

A huge proportion of the medicines that are prescribed are not actually swallowed. In medical jargon that is failure of compliance. And not complying with instructions about modern medicines can be harmful and even dangerous.

The most dramatic examples of this have been in some forms of mental illness, in which failure to keep up the treatment has led to the return of delusions and violent behaviour - even murder. But that is extremely rare: most people with mental problems would be as horrified at the thought of violence as the rest of us, and the huge majority of them take their medication exactly as advised.

It's the rest of us who are more likely to backslide. Take prescriptions for infections: they should be taken the correct number of times a day for the required number of days to make sure the infection is eradicated. Yet most people miss a few doses and end the course early, because they feel better. Or they stop because they think the antibiotic is giving them side effects - which are more likely to be the signs that the germ is dying off. Not taking the full dose or course can lead to recurrence of the infection and to resistance in the germs to antibiotics - a real problem that is growing fast and stacking up trouble for the future.

People prescribed several different medicines often make the mistake of missing out one of them. They may not want to pay for all the prescription charges, or they just don't feel they can swallow all the pills, or they feel better without one of them. That can be a disaster, especially if they are being used, for example, to keep the heart rhythm right, or to prevent strokes or heart attacks, or to avoid convulsions.

If you are doing this, please go to your doctor and discuss how you can organise your medicines better. If individual prescription charges are a real burden, consider paying an annual fee. It can save a lot of money if you have to take drugs constantly. If your problem is simply forgetting to take a tablet, wear a watch that "pings" at your medicine-taking times.

Finally, do try to understand exactly why you are taking your medicines, and what each individual drug is for. That can help you to keep taking them. People with diabetes hardly ever forget to take their dose of insulin - for the obvious reason that they know they will quickly become very ill if they don't. The principle is the same if you are on any other long term medication for a chronic illness.

The effect of forgetting or stopping your blood pressure-lowering medicines is not so immediately obvious as forgetting insulin in diabetes. Until your stroke strikes or your heart fails. Then it is a long way back to the good health you should have been enjoying all the time.

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.