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#WILTW – the importance of ‘shared’ gut feeling

This is the second in the series of “What I Learned This Week #WILTW

It was an unnerving experience to be completely let down by my own gut feeling this week. A particular case caught me by suprise and it was only through following protocol that the right decsions were made. Essentially my gut feeling told me it was unlikely extra tests would be needed for a patient, but I did them because our guidelines said so, and lo-and-behold the guidelines were right! Although initially I was a little taken a back, on reflection I’ve decided that in fact gut feeling did win the day on this occassion. Not my gut feeling – but everybody else’s…

Flock of sheep, New Zealand, Pacific

In hospital Clinical Practice Guidelines, or Standard Operating Protocols, are used to condense knowledge and experience to help healthcare professionals make decisions about patients. Ideally guidelines are based on the best evidence but often clear research is not available to determine what to do in any given situation. In these cases Guidelines are often based on the consensus of experts. This happens at a local level (consultants coming together to determine department policy) or a national level (the National Institute of Health and  Care  Excellence [NICE] bringing together expert Guideline Development Groups).

Guidelines often get a bad name as being part of the ‘tick box’ culture that often pervades health care. Perhaps it is worth thinking of them as a shared gut feeling. One that will sometimes get you out of a sticky hole.

 

What did you learn this week? #WILTW

 

What I learnt this week #WILTW

The full list of #WILTW 

A few weeks ago I posted a blog with some thoughts on becoming a new consultant. I’d postulated that having insight into learning being a  life-long journey was an essential element to being a good healthcare professional. I’ve now been in post a couple of weeks: finding my feet, performing induction rituals and thinking about the goals I would like to achieve in my next year.

online-learning

What has hit me like a bomb has been my first clinical experiences on the shop floor. It’s been an amazing learning curve, far greater than I expected actually. The pure clinical component is not really an issue. I have been acting, in some respects, in a consultant capacity for the last three years as I performed locum shifts as part of my PhD. Making clinical decisions, practical skills and running a busy emergency department are almost second nature. What struck me was how little thought I’d previously put not into ‘what‘ I was doing but ‘how‘. I am now a consultant. Clearly I don’t want to create false hierarchies, I recognise I am part of a senior team of doctors and nurses and that the title does not make me lord of the manor. However I also recognise that I have  a responsibility to role model the best possible professional and clinical behaviours. In all situations the demeanor with which I speak to colleagues, the way I approach children, young people and their families and how I interact with staff sets a tone. It’s not until now that the importance of this has become crystal clear.

I thought I knew a bit about leadership. It transpires I have a great deal to learn. Reflecting on my approach to particular challenges (mainly difficult conversations about referrals or picking up staff on sub-optimal behaviours) has demonstrated how difficult being a consistent and strong ‘leader’ is. It is very easy to take a second-best option; that in order to avoid confrontation a compromise is reached which may not be your preferred choice. But when do you draw the line? Obviously always ensuring your way is the best way is no better than always accepting the other person’s point of view. However it’s all too easy to avoid the conversation about the tone that a junior has taken (potentially accidentally) with a parent or other member of staff, for example; but it’s these conversations I need to start having.

Tough Decisions Ahead Road Sign

(via http://www.advisoranalyst.com)

So what I have I learnt this week? Well, I’ve learnt that potentially I’m not as strong as I thought I was. That some of the things I thought I would be able to do in role will take a little more embedding. I am also sure that with the guidance of colleagues and passing of time I will get better. As I said previously – the learning has only just begun again….

So what have you learnt this week? #WILTW