Category Archives: #WILTW

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What I learnt this week: It’s not you, it’s me #WILTW

This is eighth #WILTW

An interesting week which demonstrated that my learning, in many aspects of medicine, really has only just begun. This tweet resonated:

Although the context of the tweet was about #FOAMed and information transfer I read into this a more generic point:

The importance of not dropping a level to that of a potential antagonist but developing an ability to move up one level instead.

Engagement, Quality, Delivering shared values will always be a problem given the challenges of human nature. I am reminded of the need to reflect not on what others have done, but on what I can do to improve.

What have you learnt this week? #WILTW

What I learnt this week: The Challenge of Compassion #WILTW

The seventh #WILTW post

Over the last couple of years the concept of  “compassion” has increasingly been discussed in healthcare. This may seem odd – hasn’t healthcare always been compassionate? Unfortunately high profile events at numerous health care institutions have highlighted this may not have always been the case. The drive to remind health care professionals about compassion has been delivered with zest but also some incredulity. The uncertainty surrounding the reasons for obvious failings in human kindness probably the cause of different responses. Regardless of your views it is certainly always useful to reflect on your practice.

6C's

I hope I provide compassionate care. I am not sure how I ‘know‘ I do? I suppose feedback on my interactions with patients is rarely, if ever, negative and families tend to thank me when the consultation or treatment has finished. I don’t have definitive evidence of my ‘compassion’ though. This became a relevant point when during a particularly demanding shift, I realised I was having to concentrate on delivering compassionate care. I am not sure how to completely encapsulate what I mean by this but in order to engage children and their families I believe that credibility comes with enthusiasm. You must be keen to interact with children and young people. This interaction is age appropriate of course; but there is a demeanour and body language that is important to gain trust. For some this probably comes very naturally (everyone knows a Patch Adams) but I know I need to adopt almost a paediatric power pose prior to seeing patients. Completely irrespective of your clinical skills it is this compassionate approach to dealing with children and young people which families will remember.

Examination picture

 

(consent obtained for publication of this photograph)

This became increasingly difficult during the shift. I realised that I was almost resenting the effort it was taking. This is an uncomfortable state of mind to be in, challenging my own internal motivations. I hope none of the patients I saw that evening were affected by this inner tension but it has certainly given me pause for thought.

Today is the 6Cs for Everyone Event (#6CsR4E) a movement highlighting the essentials of quality care for all healthcare professionals. It is also #nhschangeday celebration day. A 12 hour long webex highlighting the powerful pledges made in healthcare communities throughout the world. I discussed my  pledge this year, lying on a spinal board for an hour, something which has clearly influenced my practice in dealing with young children with trauma. What was obvious from the webex was the enthusiasm to deliver the best possible care, all of the time, from all of the speakers and participants. I am reminded this is a necessary but sometimes demanding challenge. I will certainly be mindful of my colleagues in the closing hours of a shift  and encourage them (through a variety of ways,  humour included!) to continue to provide the care that you would want to receive yourself.

What did you learn this week? #WILTW

[The #nhschangeday webex can be joined until 2000 GMT 4/7/14 via this link ]

 

 

What I learnt this week: Remember what you loved to do… #WILTW

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.


Sepsis Six Part One

 

Sepsis Six Part Two

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

 

 

 

What I learnt this week: Accepting I’m a curator and examiner of knowledge rather than a gatekeeper of it #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

Untitled

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.

Vomitting and HI paper

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

 

 

What I learnt this week: Shared values doesn’t always mean shared vision #WILTW

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

What I learnt this week: The power of personal stories #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!)

#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