Supporting Doctors in Difficulty Dr Susan
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Supporting Doctors in Difficulty Dr Susan Gibson-Smith MBChB MRCGP MPhil Doctors in Difficulty https:www.maxpixel.netScience-Fiction-Bbc-The-Tardis-Doctor-Who-London-3713712 Aims Explore the variety of difficulties a doctor may find
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Supporting Doctors in Difficulty Dr Susan Gibson-Smith
MBChB MRCGP MPhil<br>
MBChB MRCGP MPhil<br>
02
Doctors in Difficulty https://www.maxpixel.net/Science-Fiction-Bbc-The-Tardis-Doctor-Who-London-3713712<br>
03
Aims Explore the variety of difficulties a doctor may find themselves in.
Develop an understanding of the different disciplinary and regulatory processes involved.
Equip the appraiser to provide a supportive robust appraisal.<br>
Develop an understanding of the different disciplinary and regulatory processes involved.
Equip the appraiser to provide a supportive robust appraisal.<br>
04
Question Time What types of difficulties have you encountered doctors to be facing when conducting appraisals?<br>
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Types of Difficulties FAI’s/Claims/Complaints/Ombudsman/SUI
GMC Investigations
Hospital Disciplinary Procedures
Clinical Support Group Investigations
Health<br>
GMC Investigations
Hospital Disciplinary Procedures
Clinical Support Group Investigations
Health<br>
06
Medico-legal Difficulties Complaints
Ombudsman
Claims
FAI’s
SUI’s<br>
Ombudsman
Claims
FAI’s
SUI’s<br>
07
GMC Investigations Provisional Enquiry
Interim Orders Tribunal (IOT)
Rule 4 Fact finding/expert advice/closed
Rule 7 Written allegations/28 day response/no action/warning/undertakings
MPTS Hearing Facts/ Impairment/Sanction<br>
Interim Orders Tribunal (IOT)
Rule 4 Fact finding/expert advice/closed
Rule 7 Written allegations/28 day response/no action/warning/undertakings
MPTS Hearing Facts/ Impairment/Sanction<br>
08
Hospital Disciplinary Investigation PCS8 Circular (Under review at present)
Preliminary Enquiry /recommendations/case closed.
Personal Conduct/Professional Conduct/Professional Competence.
Annexe B or Annexe C.<br>
Preliminary Enquiry /recommendations/case closed.
Personal Conduct/Professional Conduct/Professional Competence.
Annexe B or Annexe C.<br>
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Clinical Support Group Referrals Medical Director by colleagues/appraiser/GMC
Clinical Support Group consists of Medical Director, Out of Hours Lead, Local Appraisal Adviser, Nurse Lead, Practice Manager Lead, LMC Lead, Prescribing Lead.
Doctor referred to Associate Adviser for performance support
Agree objectives communication skills/peer video/SEA/prescribing/procedures and clinical governance.
Feedback to CSG discharge/monitoring/ more support<br>
Clinical Support Group consists of Medical Director, Out of Hours Lead, Local Appraisal Adviser, Nurse Lead, Practice Manager Lead, LMC Lead, Prescribing Lead.
Doctor referred to Associate Adviser for performance support
Agree objectives communication skills/peer video/SEA/prescribing/procedures and clinical governance.
Feedback to CSG discharge/monitoring/ more support<br>
10
Health Physical/Mental/Addictions
Occupational Health
GP
Specialist support<br>
Occupational Health
GP
Specialist support<br>
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Scenario 1<br>
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Developmental Process Addresses ALL aspects of a doctor’s work - including any private or OOH work, educational management roles, or any non-remunerated roles (e.g. volunteering at the local sports club or school as a doctor)
Facilitates reflection on the doctor’s practice and the submitted supporting information
Offers individuals feedback on past performance
Charts and acknowledges continuing progress
Identifies Learning Needs and agrees PDP<br>
Facilitates reflection on the doctor’s practice and the submitted supporting information
Offers individuals feedback on past performance
Charts and acknowledges continuing progress
Identifies Learning Needs and agrees PDP<br>
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https://www.maxpixel.net/Scotland-Holiday-Hike-Loch-Lomond-Nature-Travel-1747886<br>
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Why Reflection You must take part in systems of quality assurance and quality improvement to promote patient safety. This includes:
regularly reflecting on your standards of practice and the care you provide.
(Good Medical Practice paragraph 22b)<br>
regularly reflecting on your standards of practice and the care you provide.
(Good Medical Practice paragraph 22b)<br>
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Appraisal expectations re reflection Annual reflection on CPD and learning activities across a balanced range appropriate to your scope of work.
Quality improvement activities every year to demonstrate how you review the quality of your work and reflect on the standard of care you provide.
Reflection on feedback from colleagues
Reflection on feedback from patients
Reflection on all complaints involving you personally
Reflection on anything else you have been specifically asked to bring to the appraisal.<br>
Quality improvement activities every year to demonstrate how you review the quality of your work and reflect on the standard of care you provide.
Reflection on feedback from colleagues
Reflection on feedback from patients
Reflection on all complaints involving you personally
Reflection on anything else you have been specifically asked to bring to the appraisal.<br>
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The Reflective Practitioner<br>
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What is reflective practice<br>
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1. What? So what? Now what? Main example given in the joint guidance – Rolfe et al
What? – What happened? What did I do? What did others do? What did I feel? What was I trying to achieve?
So What? – So what is the importance of this? So what is the significance for me? So what is the significance for the future? How did I feel before and after?
Now What? – Now what could I do? Now what do I need to do? Now what might I do? Now what might be the consequences of this action?<br>
What? – What happened? What did I do? What did others do? What did I feel? What was I trying to achieve?
So What? – So what is the importance of this? So what is the significance for me? So what is the significance for the future? How did I feel before and after?
Now What? – Now what could I do? Now what do I need to do? Now what might I do? Now what might be the consequences of this action?<br>
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2. Reflection based on Schon Schon, D.A. (1983) The Reflective Practitioner: How professionals think in action New York: Basic books.
Reflection-IN-action Thinking ahead, analysing, experiencing, critically responding (in the moment)
What were you thinking at the time?
What was influencing that thinking?<br>
Reflection-IN-action Thinking ahead, analysing, experiencing, critically responding (in the moment)
What were you thinking at the time?
What was influencing that thinking?<br>
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Schon continued B. Reflection-ON-action
Thinking through and discussing subsequent to the situation.
What is your thinking about the event now? Having time to think, discuss, review information etc.
The effective reflective practitioner is able to recognise and explore confusing or unique (positive or negative) events that occur during practice.<br>
Thinking through and discussing subsequent to the situation.
What is your thinking about the event now? Having time to think, discuss, review information etc.
The effective reflective practitioner is able to recognise and explore confusing or unique (positive or negative) events that occur during practice.<br>
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3. What, Why, How? What do you want to reflect on?
Should contain enough information to allow you to recall the event.
Why do you want to reflect on it?
What do you hope to get out of this reflection – how will it help you?
How did you and will you learn from this?
How will this affect your practice and make you a better doctor.
How have you been affected by this?
What are your overall conclusions from this episode. How do you feel about the reflection?<br>
Should contain enough information to allow you to recall the event.
Why do you want to reflect on it?
What do you hope to get out of this reflection – how will it help you?
How did you and will you learn from this?
How will this affect your practice and make you a better doctor.
How have you been affected by this?
What are your overall conclusions from this episode. How do you feel about the reflection?<br>
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4. Gibbs’ reflective cycle Gibbs, G. (1988) Learning by doing. A guide to teaching and learning methods. Oxford Polytechnic: Oxford.
Description – what happened?
Feelings – what were you thinking and feeling?
Evaluation – what was good and bad about the experience? What went well and what went badly?
Analysis – what sense can you make of the situation?
Conclusion – what else could you have done?
Action plan – if it arose again, what would you do?<br>
Description – what happened?
Feelings – what were you thinking and feeling?
Evaluation – what was good and bad about the experience? What went well and what went badly?
Analysis – what sense can you make of the situation?
Conclusion – what else could you have done?
Action plan – if it arose again, what would you do?<br>
23
Gibbs’ reflective cycle Description
What happened? Feelings
What were you
thinking and feeling? Evaluation
What was good and
bad about the experience? Analysis
What sense can you
make of the situation? Conclusion
What else could
you have done? Action Plan
If it arose again
what would you do? Reflective Cycle<br>
What happened? Feelings
What were you
thinking and feeling? Evaluation
What was good and
bad about the experience? Analysis
What sense can you
make of the situation? Conclusion
What else could
you have done? Action Plan
If it arose again
what would you do? Reflective Cycle<br>
24
The Role of Reflection At the MPTS in support of her position part of Dr B-G’s case was that she had “reflected on and addressed her failings”
In the determinations of the MPTS when considering whether
her failings “were remediable”:
“you have undergone significant remediation and reflection…
The Tribunal…is satisfied that the risk of you putting a patient
at unwarranted risk of harm in the future is low”<br>
In the determinations of the MPTS when considering whether
her failings “were remediable”:
“you have undergone significant remediation and reflection…
The Tribunal…is satisfied that the risk of you putting a patient
at unwarranted risk of harm in the future is low”<br>
25
The Role of Reflection 2 Submissions on behalf of Dr B-G , regarding the appropriate sanction being suspension, included:
Dr B-G had demonstrated insight
She had reflected on and expressed remorse for the events<br>
Dr B-G had demonstrated insight
She had reflected on and expressed remorse for the events<br>
26
The Role of Reflection 3 The Tribunal accepted that Dr B-G had an unblemished record as a doctor, she was of good character, noted the timescales involved and that the failings occurred in the context of wider systemic failings.
BUT
“The Tribunal accepted the evidence of Dr A that you had reflected deeply and demonstrated significant and substantial insight in your conversations with him. However, the Tribunal was unable to conclude that you had complete insight into your actions as it did not hear from you directly.”<br>
BUT
“The Tribunal accepted the evidence of Dr A that you had reflected deeply and demonstrated significant and substantial insight in your conversations with him. However, the Tribunal was unable to conclude that you had complete insight into your actions as it did not hear from you directly.”<br>
27
The Role of Reflection 4 The Tribunal concluded that Dr B-G did not have complete insight
Going forward the Tribunal stated it would be assisted at the review hearing by:
“Evidence that you have reflected on the Tribunal’s findings and further evidence of reflection and insight into your actions”<br>
Going forward the Tribunal stated it would be assisted at the review hearing by:
“Evidence that you have reflected on the Tribunal’s findings and further evidence of reflection and insight into your actions”<br>
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Anonymising details in Reflection The GMC’s Guidance ‘Confidentiality: good practice in handling patient information ’gives clear direction on anonymisation in the context of using and disclosing patient information for secondary purposes, such as education and training:
Para 79: “Anonymised information will usually be sufficient for purposes other than the direct care of the patient and you must use it in preference to identifiable information wherever possible. If you disclose identifiable information, you must be satisfied that there is a legal basis for breaching confidentiality.”<br>
Para 79: “Anonymised information will usually be sufficient for purposes other than the direct care of the patient and you must use it in preference to identifiable information wherever possible. If you disclose identifiable information, you must be satisfied that there is a legal basis for breaching confidentiality.”<br>
29
Reflective Notes and the GMC The GMC does not ask a doctor to provide their reflective notes in order to investigate a concern about them. Following a significant event or a serious incident, factual details should not be recorded in reflective discussions but elsewhere, in accordance with each organisation’s relevant policies.
Evidence of insight and remediation may reduce the need for the GMC to take action. It plays an important role in how the GMC assesses whether a doctor’s fitness to practise is impaired.<br>
Evidence of insight and remediation may reduce the need for the GMC to take action. It plays an important role in how the GMC assesses whether a doctor’s fitness to practise is impaired.<br>
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In Summary Reflection is a good thing, it empowers doctors to:
demonstrate insight by identifying actions to help learning, development or improvement of practice, developing greater insight and self-awareness.
identify opportunities to improve quality and patient safety in organisations.
Reflective notes should focus on the learning, should not be a full discussion of the case and should be fully anonymised.<br>
demonstrate insight by identifying actions to help learning, development or improvement of practice, developing greater insight and self-awareness.
identify opportunities to improve quality and patient safety in organisations.
Reflective notes should focus on the learning, should not be a full discussion of the case and should be fully anonymised.<br>
31
Supporting Doctors in Difficulty Dr Susan Gibson-Smith
MBChB MRCGP MPhil<br>
MBChB MRCGP MPhil<br>