Saturday 19 November 2016

Notes from RCGP Council meeting 19 November 2016

New Chair

New Chair +Helen Stokes-Lampard set out her priorities, including encouraging delivery of GP Forward View, improving College's offer to members, and reviewing the MRCGP exam. Her vision for modernisation of College seems to include more transparency: her first action was to allow tweets from Council to be live (i.e. removing the one hour delay).

GP Forward View

There was extensive debate about GP Forward View, in which Council considered concerns about its implementation. College will shortly publish an assessment report on implementation.

Membership by Assessment of Performance

Council approved a proposal to allow prospective members more time (five years, to tie in with revalidation cycle) to collect evidence to support application for Membership by Assessment of Performance (MAP).

I suggested that candidates be allowed to collect evidence across each criterion over the whole five years to allow more flexibility. This was not accepted; each criterion will have to be achieved over one year.

I also suggested that we consider allowing nomination to fellowship of non-members. Many leading GPs are not members, either because they qualified before MRCGP was a requirement or because their membership has lapsed, but would otherwise be ideal candidates for fellowship and therefore potential new members. President +Terry Kemple promised this would be explored during the review he plans to lead.

Friday 11 November 2016

From the medical student in the corner: how my GP placement changed my practice...

Students are, quite rightly, encouraged to go with that natural urge to empathise with our patients. However, little is taught about protecting your emotional self. For example I saw a 50 year old lady suffering greatly with anxiety. I felt upset, and thought about her many times in the evening and over the weekends. Feeling this way with multiple patients was exhausting, so out of necessity I reluctantly started learning to distance my own emotions.

From speaking to colleagues and watching consultations I learnt that treating the patient in the best possible way doesn’t require me to wholly and completely emotionally invest in each case I see. On reflection, I realise that objectivity fosters logic and rationale and therefore probably better patient care. Equally, I also recognise that I’m human and it will still get to me sometimes.

The lady mentioned above did not want medication or a sick note. She needed somewhere to unburden, and someone to monitor her mental health. Being inexperienced, I felt uneasy not actively doing anything for her. I am learning that where a competent patient refuses any action (and it’s clinically sound to acquiesce) active listening can be therapeutic. Writing her name on a prescription pad to make myself feel better has ethical implications; not only in and of itself, but also practical ones in exposing the patient to unnecessary risks and side effects.

Conversely, problems also arise when the patient is expecting a particular course of action to be taken. Take, for example, antibiotics. I witnessed and tried replicating multiple brilliant explanations about the dangers of resistant bacteria, after which the patient no longer wanted antibiotics. Part of the skill here is eliciting the patient’s agenda early on so that it can be overtly addressed, and the patient leaves feeling safely treated.

Before this GP placement, in my independent consultations I would always avoid addressing management options where I knew the patient’s agenda was not going to match the best treatment option, antibiotics or otherwise. I would leave the GP tutor to address the mismatch of expectations versus reality when they reviewed the patient with me afterwards.

Now I address it myself, albeit with varying degrees of success which there are not sufficient words to explore here.

In summary, I now see the value of doing nothing, addressing the patient’s agenda even when it’s hidden and finally protecting my emotional state: not big headings on the curriculum, but nonetheless changes I have made.

My GP placement this year changed much of my practice. In fact I went from being unsure about medicine as a career, to knowing that I would definitely thrive in community medicine.