Welcome to this Medical Appraisal Skills Video Workshop.
This is one of a series of short films intended to explore some of the challenges presented
by medical appraisal conversations, and to encourage you to consider helpful behaviours,
strategies, and mind-sets for these important meetings.
The purpose of this scene is to look at how we can support doctors to embrace quality
improvement.
Let’s join our doctor’s mid-appraisal.
INT: So, finishing off patient feedback.
F: Mmm-mm.
INT: Looking here there’s some really good positive comments.
F: Yeah, although some people have said that my communication isn’t very good.
INT: Okay, that’s true.
There are a few comments like that, why do you think that is?
F: Well probably because I’m not here very often.
INT: Mmm.
So-so your communication can’t be timely I suppose?
F: Yeah, that’s pretty fair.
INT: Okay so, have you erm ever thought about maybe spending time reflecting on our approach
to patients, and the impact that you have?
F: Not really, I mean I come in, I do my job, and then I go.
It’s not hugely satisfying.
INT: (Pause) Tell me more.
Notice that very simple prompt from the appraiser, ‘Tell me more’.
This is one of several quite useful phrases to consider using in these conversations,
which can be remembered as TED: Tell me.
Explain.
Describe.
INT: Tell me more.
F: Well, you know I work in isolation a lot.
Erm, I do two days a week, I come in I do my job and… and then I go like I said.
I suppose I can understand why patients feel that my communication isn’t very timely,
because if they have results er, or if they’re waiting for test results er they have to wait
until I’m next in.
Erm, and I can understand that, that-that can be frustrating.
INT: So how-how do the partners manage that, because they must have the same issues?
F: The partners, I don’t really communicate with the partners about this, you know.
If-if a test results…
if their test result is (pause) is urgent, I might inform the receptionist to keep an
eye out for them, or the lab might call the surgery directly.
Erm, but I don’t really speak to the partners about-about that.
INT: I’m worried about this Doctor’s lack of engagement, there is obviously no support.
Take a moment now to discuss how you can help a doctor who appears to be isolated.
Let’s see how our appraiser handles this.
INT: So there doesn’t seem to be any system in place there.
It does seem as if you are working on your own, a lot.
How do you feel about that?
F: Yeah I am working alone a lot, I feel that I’m, like I said, isolated.
Erm (pause), yeah it’s hard, it…
I don’t feel engaged with-with the surgery and the practice really.
Erm (pause) I come and do my bit and I don’t know if I really have any right to-to be engaged
or to-to ask people for things, because everyone is busy, and everyone has their own patients.
Erm…
INT: I think you absolutely do have a right.
It sounds to me that the issue is around support, that you don’t feel supported, and therefore
you don’t have the confidence…
F: Yeah.
INT: … to ask for what you need.
Where do you think you could get that support?
F: Erm (pause) well I suppose there are other sessional GPs working in the practice, erm
(pause) I’ve never had a conversation with them you know.
Maybe-maybe they feel the same way that I do, I-I don’t know, that might be a good
place to start is to have a conversation with them erm, and-and find out how we might be
able to support each other.
INT: I think that’s a great idea because, you know if you buddy up possibly with-with
one or two other people then you can actively check each other’s messages, and hopefully
that will improve communication with patients.
F: Yeah, that’s a good point.
Mmm-mm.
INT: Anywhere else you can find support within the practice?
F: Erm (sigh), apart from the receptionists, erm (pause) yeah you-you know honestly speaking,
I-I probably should have a conversation with the partners, I probably should find that
engagement, and erm and share best practice…
INT: Mmm.
F: Because of course I experience things er being a sessional GP, that they might not
experience, and vice-versa.
And to ask them for their expertise, I just need to go ahead and do that really.
INT: I think it’s…
I think it’s really important that you do, do that.
Erm obviously, discussing working practice erm with the partners I think is something
that’s incredibly worthwhile for you to do.
You talk about communication with your patients, and we have some evidence of that, and I think
any failures there may be a reflection to some extent on the communication between you
and the partners actually.
F: Yeah, good point.
INT: So, yeah I… so I wonder if we can focus a bit on that; or you can focus a bit on that
if we would see an impact on your relationship with the patients.
F: Yeah.
Yeah, it would be interesting to know in a year’s time if-if the patients feel differently
once I have these conversations.
I mean, they’re not easy conversations to have, because everyone’s busy…
INT: Mmm.
F: And I don’t want to take up anyone’s time, erm but like you said I-I think we’ve
reached the point where it’s-it’s important to have that conversation.
For me, ... INT: Absolutely
F: To find that engagement again.
INT: Well let’s make this a QII item on your PDP.
F: Okay.
INT: So we can look at erm getting some patient feedback again in a year’s time.
F: Okay.
INT: Because if you get that support network in place, erm and start having case reviews
with the partners, I think you will see some interesting developments in that area.
Erm, and also make sure that you are doing those case reviews and best practice with
the partners, that’s another QII item that we can… we can… we can put down there.
F: Okay.
INT: Erm, great.
Let’s itemise that on your PDP…
F: Yeah.
INT: … erm, when we’ve got to the end of this session.
F: Okay.
INT: Erm, and see what else we can also include on that.
F: Okay.
INT: Okay, good.
F: Mmm-mm.
Further information of quality improvement can be found on the GMC and the Royal College’s
websites.
Finally, based on your discussions with your colleagues and what you’ve learned through
watching this film, what are some helpful ground rules or tips for these conversations?