Category Archives: #WILTW

Blogs relating to What I learnt this week

What I learnt this week: It’s not what you say it is how you say it #WILTW

This is the twelfth #WILTW

What could directly link a peer reviewed academic article in a medical journal and a comedy sketch on eyebrows?

The importance of being able to read facial expressions.

One of my favourite comedy sketches is performed by Jim Eion

Published in the Emergency Medical Journal last month was this article 

EMJ

 

Essentially patients with serious heart diseases lacked facial expression variability and surprise in response to certain stimuli which should provoke grimacing/laughter etc. I am uncertain at the moment what implications this will have for medical practice in the future but I am sure it is an important finding.

I try to stress to the junior doctors in our department, especially as we have a completely new set with us for the August handover, that it is important not just to take a history but really listen to what is being said. Often parents of children who are unwell have concerns that they don’t always fully express with words. Furthermore a great deal of communication is delivered through body action and facial movements rather than actual language. For example the subtle withdrawn demeanour of the mother who has post-natal depression is only noticed if you are actively observing for it [Further examples of this can be found in my quick guide to managing the febrile child]

It is not just with patients that observation of facial expression is vital. In dealing with colleagues at meetings and handovers it is vital that you are constantly observing the way things are said as well as what is said. The inability to read others tone and facial expression is a common reason for the development of poor working relationships in my humble opinion.

The next time you talk a history from a patient or have a discussion with another speciality: Are you just listening to what is being said or watching as well?

What did you learn this week? #WILTW

What I learnt this week: The importance of being part of a team (Sir Bradley Wiggins says so!) #WILTW

This is the eleventh #WILTW post

Hours after winning a silver medal at the Commonwealth Games Sir Bradley Wiggins gave the following interview to the BBC:

http://www.bbc.co.uk/sport/0/commonwealth-games/28477534

It was a honest account of what the team had achieved in Glasgow. He also noted that he had struggled with the “not-so-niceties” of the highly competitive nature of the Tour-de-France. What stood out for me was his comment about looking forward to returning to being part of a true team. The team pursuit is dependant on everyone, not just a one highly skilled individual.

Emergency Medicine is very similar. When it gets very busy, with large patient volumes and high acuities every health care professional plays a vital part in ensuring patient safety and a quality experience for all. It is that collaborative experience that makes emergency medicine such a fun place to work. I can try and see as many patients as possible but without the health care assistant, nurse, ward clerk and manager all playing their roles it will be a deeply unsatisfying experience. Even during the busiest periods, a quick joke and a smile between members of staff makes a huge difference.

We are one Team

So I’m with Bradley – while the individual reward may be worthwhile in the short term nothing beats a team effort…

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What I learnt this week: Learning not to be as busy as a “Backson” #WILTW

This is the tenth #WILTW post

On the long journey to and from our holiday in Wales our girls were entertained with an iPad playing a variety of disney films and Peppa Pig episodes. One of their favourite films is Winnie the Pooh ( 2011)

It features a catchy song about the Backson

Owl:         Christopher Robin has been captured!
[all]:        What?
Owl:        By a creature called “The Backson.”
[all gasp]
All:          Captured by the Backson!
Tiger:     What’s a Backson?

Owl:       A horrible creature! Malicious!
Tiger:     You don’t say.
Owl:       Ferocious!
Tiger:     Fero… ?! Ooh!
Owl:       And worst of all, terribly busy.

(I suspect you’ll find it impossible not to sing along after you have listened a couple a times)

I used to take pride in the fact that I was always busy. A badge of honour almost. Having spent a week away from work and being able to properly relax I realise I have no less work to do now than I did before I left (and probably more). However I am now infinitely more chilled and less stressed about my to-do list.  While I’m unlikely to completely change all my working habits I am going to try an hold on to the image of the ‘terribly busy’ Backson to remind me of the importance of a good holiday 🙂

Beach View

 

What did you learn this week? #WILTW

 

 

What I learnt this week: Feel the fear and do it anyway #WILTW

The ninth #WILTW post

I recently visited the Wellcome Trust exhibition: “an idiosyncratic A to Z of the human condition“. I thoroughly recommend it as, not only is it free, but it does really get you thinking about different mindsets and idiologies. I was struck by this particular exhibit

dustbin

I would not generally think of myself as someone who is afraid to do things but it was interesting that I thought of many fears I would like to put in the bin. My transition to being a consultant has generated a great deal of self-reflection and I hope self-efficacy (thanks to Helen Bevan for highlighting the difference)

selfefficacy

 

Actually there are many things I have been afraid to do – but by not recognising them as fears I have not challenged them. Hoping the rubbish bin approach will help me be more honest in future!

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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.

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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.

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[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