Action Points: Managing Medical Complexity

Action Points for the Competency Rating Scales

  • Write a log entry ideally on the simultaneous management of chronic and acute issues.
  • Write a log entry ideally on discussing risk with a patient or family and the challenge of managing uncertainty either for you or the patient / family.
  • You need to plan for how to achieve evidence on this competency (medical complexity), choosing appropriate CbD cases will help, and ensuring that there are appropriately chosen log entries or SEA easily linkable to this competence.
  • Remember to take every opportunity to promote health and prevent disease. This is not always evident from learning log entries, so write two specifically looking at how you did this.
  • It would be great to see a learning log entry on your management of a patient with, for instance, chronic pain and how you manage with promoting a return to normal function. There are other situations where management can be very complex and involve strategies and the use of members of the extended team to help support the patient. End-of-Life care is often a good case to use to demonstrate this competence.
  • When you see a complex patient it often takes several consultations before you can really address all the issues you find. Add a clinical encounter once you have seen the patient several times to give a picture of how you addressed all the issues and how you prioritised what you did initially and in what order things are addressed. These types of patients are also great for CbDs.
  • Provide more evidence in the form of learning log entries of your ability to treat multiple conditions in a patient. CbDs are good for this as are end-of-life care patients, or complex arteriopaths.
  • You need to ensure you provide more evidence for this domain by selecting clinical encounters and SEAs that demonstrate you are able to deal with multiple chronic and acute problems at the same time. Choose CbDs carefully so you will cover this competence, but remember that you’ll need several log entries too to demonstrate practice well.
  • It is common to have difficulty demonstrating this competence in hospital practice, as hospitals do not consistently look at the complexity angle but itemise problems. You will need to look at this, and how to manage in GP many more log diary entries, etc. It will be important to concentrate on these word pictures when writing entries.
  • Consider the relationship between acute and chronic problems in children presenting to A&E as well as issues of uncertainty and risk.
  • I think it would be helpful to reflect on the wording in the ‘excellent’ section of the word picture below, particularly: ‘Accepts responsibility for coordinating the management of the patient’s acute and chronic problems over time’ – how will you put this into practice in the future?
  • As this area is hard to score in CSR or COTs without specific comments you can’t rely on CBDs here – more log entries mentioning the complexity to alert the CS to this competence will be essential before the next panel.
  • You need cases to discuss at CBD which also overlap as log entries as well as cover your lack of many curriculum statement areas.
  • Coping with complexity and hence uncertainty is the bedrock of a good GP. You must look out for more cases to demonstrate this in CBD in the next 6m as well as making sure to discuss at debriefs and record these as an example of learning on e-P.
  • Home visits are often a source of complexity so try and write these up whenever possible reflecting thinking about the competent and excellent word pictures of medical complexity.
  • Use a narrative approach to family and describe the complexity of their condition and why you feel they are complex and how their condition affects them.
  • Continue to reflect on managing uncertainty. Gain experience in managing multiple problems simultaneously and reflect on this on e-P and in your choice of CbDs.