Action Points: Practising Holistically.

 Action Points for the Competency Rating Scales

  • Use experience of the elderly and terminal care to detail in log entries the significant interaction between patient’s context and their experience of health.
  • Video work as for consultation consider writing down on a card after each consultation whether you know the occupation , (interests,) effect on life of the problem of each patient, or their family ask your trainer to debrief on this each surgery for all patients as well as the ones you medically need to discuss
  • The challenge is going to be – How do you gather a detailed psycho-social history and practice holistically and keep to time? I suggest trying to have a focused and structured consultation should allow you to do this in the constraints of a ten minute consultation. Choose 3 occasions when you significantly over ran and reflect on what happened in your e-P
  • Continue being curious and understanding the different impact similar illnesses can have on different people. Remember, you need to be able to get a psychosocial history within the time constraints of a 10 minute consultation. Use your e-p to demonstrate times this has worked or you have struggled… think what was the difference.
  • Be curious. British patients expect their doctor to ask them questions and appreciate it when the doctor really understands how their problem is impacting on their and their family and carer’s lives. They would not consider this rude or nosey. Consider how you might become more familiar with British culture – trainees in the past have found listening to the radio – Radio Sheffield for instance, watching the soap operas – Eastenders, Coronation Street, Emmerdale and watching British films can help them to understand British humour and family and community norms and culture. It is great if you reflect on learning from outside medicine in your e-P; please do this!
  • Continue to be curious and inquisitive in order to ensure you offer the most appropriate management plan for each patient. Get feedback from those who observe you on this, and/ or reflect on this in e-P.
  • Continue to provide evidence from COTs, CbDs and learning log entries to demonstrate this competence. Learning log entries should demonstrate you are able to manage patients with complex psychosocial problems and adjust your management plans accordingly.
  • Consider how to develop these skills in the context of your next posts specifically in Paediatrics and A&E. Consider impact of problems and interaction with other services, e.g. social care/safeguarding and document this learning in your e-P.
  • Read the word pictures and develop understanding of this competence and demonstrate this more fully in GP. Some trainees find it helpful to start their e-P entries with the competencies they think they are reflecting on. Try this!
  • Paediatrics will give you a great opportunity to document how disease and medicine impacts on families and children. Reflect on this in you LLEs.
  • As you move into GP this domain becomes easier to look at. Please collect evidence of your progression not just in COT and CbD but also by writing LLEs which you have planned to allow demonstration of this competence.
  • Think about psychosocial impact of disease as you start GP next month.
  • You need to continue to reflect on holism in GP context. It will be important to think more possibly about the socio-economic context of patients and how this affects their ability to cope with GP care. And share this learning on e-P.
  • You are planning to start in a permanent GP position soon. I would encourage you to look at actively following up some patients, building enduring relationships with them and their families/carers. This can be one of the most rewarding aspects of being a GP.
  • Look for difficult consultations or histories which may hide something at home, work or background that are causing problems – this may also be helpful later in the consultation in the shared planning stage.
  • You need to choose cases to show this in CBDs as not enough so far. COTs can be joint surgeries but also videos which if appropriate can be discussed to show this.
  • Use your natural empathy to gain this information but be aware of not acting as a sponge – more reflection to the patient leads to shared understanding.
  • This is a critical part of understanding the patient’s agenda and understanding so keep making sure you explore this and demonstrate how you are doing this on e-P.
  • You should consider doing three log entries where circumstance/social/work etc impacts on patients presentations.
  • Going into Paediatrics you need to take a child with a long term condition and have a go at the narrative approach to the family and impact on them of sibling’s illness. Discuss as a CBD as well.
  • Document cases with strong holistic care issues, and when an understanding of socio-economic background or culture has helped.

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