The sixth #WILTW post
I was fortunate enough to attend Agents for Change (#A4C2014) this week. An annual event since 2008 it was where I first learnt the value I could provide to the entire health system, not just individual patients. I delivered a short workshop with Jeremy Tong about the challenge junior doctors face in delivering change. We spoke about narrative and the importance of personal stories in engaging with others, something we learnt a great deal about during #nhschangeday. Jeremy has an extremely powerful story about his personal experiences of sepsis which clearly have focused his efforts on developing the paediatric sepsis six tool.
Anyway I digress from the point in hand! The conference started with an introduction from Fiona Godlee, editor of the BMJ. She revealed the following:
and described how doctors typically have a huge range of talents, not just academic ability, which makes competition for medical school very intense. I have always thought that doctors are actually spineless. Generally at school they have one thing they are really good at but don’t have the guts to pursue that as a career/vocation and medicine becomes the safe choice. It made me reflect on my visit to the Foxton Locks Festival last weekend. There was a circus skills area and I got a chance to play around with toys I haven’t had fun with since being at school. I’ll be honest there is no way I could have made a career as a juggler but it was certainly something I’d forgotten I could do.
I’m sure others have other ‘outside of medicine’ skills. Just looking through the range of #FOAMed material delivered by singing, artistry or technological wizardry proves this. If you’ve let something you enjoyed doing slip in the last few years this is a reminder to pick up it again. You might just enjoy it.
What have you learnt this week? #WILTW
The fifth #WILTW post
So I could have written about 5 different blogs such was the intensity of learning this week! A few of them probably need more reflection so I leave you with this; a little more medical than usual but I hope understandable to all.
One of my consultant colleagues sent around this interesting website: xrayrisk.com
This was timely as I have only just been reviewing the latest evidence on when you need to do a Head CT (brain scan) in children who have a head injury and their only symptom is vomiting. This recent paper makes interesting reading.
Essentially if your child has a head injury and they only have vomiting afterwards it’s likely they don’t have anything seriously wrong with them. Paediatrician’s have always felt uncomfortable about CT scanning children uncessarily as their chance of developing a brain tumour may increase. This assumption has recently been challenged but I think remains a valid concern. The interesting thing about this x-ray risk website and similar resources is how is this publicly available information going to be used? Is it possible a parent may come to the Emergency Department and know more about the risks/benefits of scanning children with a head injury than I do? Although this may seem uncomfortable I think clinicians are increasingly becoming curators and examiners of knowledge rather than gatekeepers of it (the #FOAMed world is a great example of this). What is important is that we are aware of the common sources of information that patients and their families may use and know the values and evidence base behind them. This acceptance comes with the responsibility of trying to be familiar with the sources of information available. So if anyone does use x-rayrisk.com and spots something interesting please let me know!
What did you learn this week? #WITLW
The fourth #WILTW post…
I’ve been mulling over the reasons why, even in groups of people who get on very well, there can sometimes be discord on direction or strategy. Since the Francis report there has been much written on culture, compassion, shared values and engagement. Less has been actioned to improve these things and less still proven to have made significant change. Why is this? Given the fact that the core essence of what staff do in healthcare is centered on a few key values why can’t we create environments where these shared beliefs are harnessed in ways that inspire improvement in the care of patients and each other.
I attended a session with the #NHSChangeday hubbies this week, and on the same day, a national strategy meeting about improving the management of the deteriorating child. At both groups it was clear the values of the individuals attending were very similar. Converting this into a shared vision of what was needed to achieve the objectives of the group may have been tricky. In very different ways both groups used the core values of those present to remain focused on creating a shared vision. Not always an easy process, but an important method to bring everyone together. I’m not entirely clear there is one best way to do this but I’m certainly open to experiencing as many as possible.
However it happens given the challenges facing a post-Francis NHS translating values into vision will be an important process.
What did you learn this week? #WILTW
This is the third in the series of #WILTW
I seem to have discovered this viral video extremely late:
It tells an uncomfortable story of Social Media use which is a little cheesy in places and clearly ironic in its success. It is however a powerful film. I have been a convert to the importance of story telling through my involvement in NHS Change Day. Previously dismissiveness of those who celebrated individual case studies as a means of getting their message across I am now a firm believer in the importance of personal narrative. I highly recommend this short Petcha Kutcha style presentation if you are unsure.
This week I attended the second day of the Children and Young Peoples Outcomes Forum annual summit where we spent some time discussing the difficulties of data sharing. My views on this are very strong (see this blog for the background) and I am wary of letting my frustrations stop productive conversation. It struck me though that my most useful contribution to the debate was not any technical argument or counter assertion about risks/benefits but the simple personal story of why data sharing is important to me. Essentially a child may have come to harm because simple information was not able to be flagged up to me through a universal database (as intended by contact point). It was a story that others could relate to and provided a common ground for all.
I may well be preaching to the converted but my learning this week is to not be afraid to use personal narrative as a means of engagement. It may well be the best argument you have.
What did you learn this week? #WILTW
(thanks to my wife, Katie, for pointing out the Looking up video!)
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…
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
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.
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.
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