The best doctors in the world still have bad consultation. Sometimes you just start off on the wrong foot. The patient leaving in a floor of tears is usually an indication that this has just occurred. On one of my medical placements I witnessed one such consultation.
A young woman in the early stages of her pregnancy had a per vaginal bleed and wanted a scan to see if the pregnancy was still ok. Medically speaking, a scan wasn’t indicated as the pregnancy was too early on to detect any changes. The doctors noted the “agenda” as they later remarked, and was not going to “play the game” and send the young woman for a scan. She was not happy about this.
The doctor felt that he couldn’t have done more. Medically there was nothing he could offer to the woman other than advice to go home and wait a little while before repeating a pregnancy test.
To me, there was lots that could have been done. This woman was scared and worried and a sympathetic ear and a tissue would have gone some way to making her feel better. The doctor I was with couldn’t see this. They were blind sighted by the repeated requests for a scan and slightly frustrated that the unhelpfulness of this was not being understood.
When the young woman began to cry I was waiting for the doctor to hand over a tissue. “Any second now...” I thought, but it never happened. I wanted to give the woman a tissue and put my arm around her but that would have meant physically placing myself between the doctor and the patients and interrupting a consultation I wasn’t really a part of.
But the truth is. I was a part of that consultation. I might not have been the doctor in charge but I was another person in that room who could have made that situation easier for that patient and I didn’t.
Hours later, on my way home, I was still thinking about this. I felt I had let that woman down. I could see what she needed and I sat there and did nothing. After the consultation I immediately told the doctor what I thought. I felt that the patient had been let down. They took on what I said and mostly agreed with it. All egos were put aside in that frank conversation and the doctor genuinely reflected on how they could have done better in that situation. It wasn’t about me or the doctor. It was about the patient.
As a medical student it is easy to feel in the way in the hospital environment or in a busy clinic. When the consultant is running behind, it takes a lot to ask the patients something or butt in and add something you think is relevant that in the end may turn out to be a very trivial thing. But at the end of the day, it is worth it if it means that there is a better out come for the patient because when all is said and done they are the ones we are doing this all for. I regret not handing that patient a tissue and it’s a mistake I hope never to repeat again.
What's the problem?
Since I first started working with doctors, one of the main complaints I've heard is about electronic portfolios:
"It's so slow",
"It's really ugly",
"It's basically unusable",
"It crashed the day before submissions!",
"It's SO unintuitive"
I've heard all of these things from different doctors at different stages in different specialities in different locations. Write a tweet about ePortfolio and the odds are you'll have it retweeted and replied to numerous times within minutes. There's clearly a real problem here, and a real frustration among doctors!
What's the Solution?
Over the last two years I've spent lots of time talking to a variety of doctors about this and have come to the conclusion that a new modern, robust solution is needed. We need software that is fresh and intuitive to use, that doesn't get overloaded and that has the features that people actually want!
The Meducation team agrees, and so we've partnered up with our friends at Podmedics to make this a reality. We are making oPortfolio - the Open Portfolio - an open-source system guided by the needs of the trusts, deanaries and colleges, but with a firm focus on the doctors who will be using it. Over the next few days we'll be launching a kickstarter project to let you support what we're doing. In the meantime, please sign up on our website to receive updates about what we're doing!
Last Wednesday (27/11/13) was Birmingham Medical Leadership Society’s second lecture in its autumn series on why healthcare professionals should become involved in management and leadership.
Firstly, a really big thank you to Mr Smart for travelling all the way to Birmingham for free (!) to speak to us. It was a brilliant event and certainly sparked some debate. A second big thank you to Michelle and Angie – the University of Birmingham Alumni and marketing team who helped organise this event and recorded it – a video will hopefully be available online soon.
Mr Tim Smart is the CEO of King’s NHS Foundation Trust and has been for the last few years – a period in which King’s has had some of the most successive hospital statistics in the UK. Is there a secret to managing such a successful hospital?
“It’s a people business. Patients are what we are here for and we must never forget that”
Mr Smart doesn’t enjoy giving lectures, so instead he had an “intimate chat” covering his personal philosophy of why we as medical students and junior doctors should consider a career in management at some point.
Good managers should be people persons. Doctors are selected for being good at talking to and listening to people – these are directly translatable skills.
Good managers should be team leaders. Medicine is becoming more and more a team occupation, we are all trained to work, think and act as a team and especially doctors are expected to know how to lead this team. Again, a directly transferable skill.
Good managers need to know how to make decisions based on incomplete knowledge and basic statistics. Doctors make life-altering clinical decisions every day based statistics and incomplete knowledge. A very important directly transferable skill.
Good managers get out of their offices, meet the staff and walk around their empires. Doctors, whether surgeons, GP’s or radiologists have to walk around the hospitals on their routine business and have to deal with a huge variety of staff from every level. To be a great doctor you need to know how to get the best out of the staff around you, to get the tasks done that your patients’ need. Directly transferable skills.
Good managers are quick on the up-take and are always looking for new ways to improve their departments. Doctors have to stay on top of the literature and are committed to a life-time of learning new and complex topics. Directly transferable.
Good managers are honest and put in place systems that try to prevent bad situations occurring again. Good doctors are honest and own up when they make a mistake, they then try to ensure that that mistake isn’t made again. Directly Transferable.
Even good managers sometimes have difficulties getting doctors to do what they want – because the managers are not doctors. Doctors that become managers still have the professional reputation of a doctor. A very transferable asset that can be used to encourage their colleagues to do what should be done.
A good manager values their staff – especially the nurses. A good doctor knows just how important the nurses, ODP, physio’s and other healthcare professionals and hospital staff are. This is one of the best reasons why doctors should get involved with management. We understand the front line. We know the troops. We know the problems. We are more than capable of thinking of some of the solutions!
“Project management isn’t magic”
“Everything done within a hospital should be to benefit patients – therefore everything in the hospital should be answerable to patients, including the hospital shop!”
“Reward excellence, otherwise you get mediocrity”
At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite.
Email us at email@example.com
Follow us on Twitter @UoBMedLeaders
Find us on Facebook @ https://www.facebook.com/groups/676838225676202/
Come along to our up coming events…
Thursday 5th December LT3 Medical School, 6pm
‘Why should doctors get involved in management’
By Dr Mark Newbold, CEO of BHH NHS Trust
Wednesday 22nd January 2014 LT3 Medical School, 6pm
‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’
By Prof Jon Glasby, Director of the Health Services Management Centre , UoB
Thursday 20th February LT3 Medical School, 6pm
‘Creating a Major Trauma Unit at the UHB Trust’
By Sir Prof Keith Porter, Professor of Traumatology, UHB
Saturday 8th March LT3 Medical School, 1pm
‘Applying the Theory of Constraints to Healthcare
By Mr A Dinham and J Nieboer ,QFI Consulting
Itraconazole is an antifungal drug used widely to treat fungal infections and is active against Aspergillus, Candida and Cryptococcus. It is effective and now much cheaper as it has passed out of the period of time granted to its inventor to exclusively sell it - there are now several competing manufacturers. It seems to be an increasingly useful and used drug now it has become more accessible which is a good thing in the main but this makes it increasingly important that this drug is properly understood and its very severe potential side effects appreciated and guarded against.
These are the warnings published by the World Health Organisation
Risk of congestive heart failure
The agency says that while the available evidence suggests that the risk of heart failure with short courses of itraconazole is low in healthy, young patients, prescribers should exercise caution when prescribing the drug to at-risk patients. Amendments to the product information of all itraconazole formulations have been made to reflect this information.
Risk to pregnant women
By April 2000 the UMC had received 43 case reports from 5 countries regarding the use of itraconazole by pregnant women. 25 of these pregnancies ended in embryonic or foetal death. The remaining 19 reports described a variety of congenital malformation or neonatal disorders. In the 38 reports in which the route of administration was specified the drug was taken orally. The data suggested that:
inspite of the approved recommendations and warnings itraconazole is being taken by pregnant women for minor indications,
reported human experience seems to lend support to the experimental evidence that itraconazole is teratogenic,
there is a predominance of abortion, and
more firm warnings may be needed in the product information.Although not apparent from the UMC reports, a further question of interest was if itraconazole might decrease the reliability of oral contraceptives and so lead to unintended exposure in pregnancy.
Care thus needs to be taken about which patients are prescribed itraconazole, adequate monitoring needs to be put in place if needed and sufficient advice given with the drug to ensure the patient is aware of the risks involved and the signs & symptoms to look out for.