Week 2: the Best Laid Plans…

Apologies for any Of Mice and Men PTSD from the title, but this saying ends with “often go awry”. In medicine, disruptions are a daily occurrence and new situations present themselves to even the most experienced of doctors.

This week on GP was very much a week of disruptions. Ordinarily, when things go wrong the knee-jerk reaction is to panic. However, I found that my experiences of cognitive reframing and stress management had profound positive effects on my response. In short, the techniques work!

Surprise 1: a change of system

Communication is vital in medicine. I was tasked with seeing patients alongside a wonderful Nurse Practitioner, which was going very well until we received a message: your 1:30 patient has been waiting, just to check you’re looking at the student list. It was 1:47. It turns out, I had patients to see on another list, and had this thoughtful GP not messaged us that patient would have been waiting for a while!

The patient was a busy professional and could have made things harder for me, but I decided the best approach was to apologise, explain the situation and see if they were still happy to see me. The temptation here is to roll over and over-apologise, which is not only damaging mentally but also reduces the professional pedestal we have to put ourselves on, almost as a protective mechanism. Luckily the patient was still happy to see me.

The second temptation is to then rush the consultation. In the past, I would have done this out of guilt and quickly rushed the nurse in to present. The problem with this is, I would have less information and less insight to give the nurse, so they would have to repeat everything I did anyway.

In the end the consultation was quite interesting and the patient was able to get the medication they needed. However, for me this was a reminder that surprises can crop up at any stage, and the best way to approach them is to:

  1. Take a breath and assess the situation
  2. Focus on the patient’s needs
  3. Reframe the inner voice telling you its your fault, you aren’t good enough and the patient (and team) are judging you.

Surprise 2: sink or swim

It was a run-of-the-mill phone consultation, supervised by the GP. A patient with a significant cardiovascular and limb ischaemia (essentially, poor blood circulation to the legs causing problems with ulcers, healing and nerves).

The patient had several issues to discuss with me so my focus was history taking. The GP was typing up the notes alongside (just to clarify, the patient gave their consent to speak to me and knew the GP was listening). Then suddenly:

“Oh Hardeep, the other students are calling me into the room, I’ll be back shortly”

The GP was needed elsewhere. It was just me, on the phone with the patient, with no idea how long the GP would be away for. It was one of those situations where having that safety net at the beginning meant the anxiety was only present because the safety net was taken away.

In the past, this would have caused me to overthink the situation. I would have been concerned with overstepping my professional boundaries, asking questions that weren’t relevant and generally making mistakes. However, I knew the GP would be calling the patient back anyway, so I figured I should explore the issues as much as I could.

I ended up speaking to her for a good ten minutes (probably twenty minutes in total) and had a list of nine separate problems she needed to address. The GP still wasn’t back, so I decided to write up the notes on the system, writing each problem down clearly and trying to include any relevant information.

By taking the initiative and not overthinking, I was able to explore this patient’s problems, get all the relevant information to the GP and not waste any time. This might seem like a small win, but I know that this situation would have ended very differently a year ago. Plus, in medicine any win is worth celebrating.

Overall this week, I managed to challenge myself and sign off quite a few skills (massive thanks to Rachel, James and the staff for helping me). Signing off urinalysis led to two separate UTI diagnoses, so it was certainly helpful!

Surprise 3 came at the end of the week. A staff member tested positive for Covid-19. I admit that the panic was slightly higher when we were told but again, I was able to control the stress and focus on what needed to be done.

Luckily, I had no contact with this member and a subsequent test came back negative, but in this era of a global pandemic and a constantly changing political environment, being prepared for disruptions is about all we can hope to do.

Next week I start oncology- let’s see how that goes!

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