Need for a forum where young doctors can express feelings about patients
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i759 (Published 09 February 2016) Cite this as: BMJ 2016;352:i759
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Whilst we agree that a forum for junior doctors and trainees to express their feelings without condemnation or judgement is vitally needed, we would suggest that senior clinicians could benefit from these too. These forums would give them a chance to express feelings, reflect on them, test out their assumptions and consider their actions in the light of the compassionate and excellent professional behaviour which they aspire to achieve.
There are several barriers to achieving this; failure to see the value of these groups, lack of buy in from colleagues and the culture in which they practice.
Over the past 3 years we have run such forums for Undergraduate Clinical Students at the School of Clinical Medicine in Cambridge. We call these ‘Professional Practice Groups’ (PPGs); small reflective practice groups of 5-6 students run by an experienced clinician. Topics covered include ‘Professional Boundaries’, ‘Unprofessional Behaviour in Clinical Practice’ and ‘Self-Awareness’. These groups are fundamentally important to our Professionalism Curriculum and, when facilitated well can be a transformative experience for both students and facilitator.
Other group forums which allow reflection such as this include Balint groups (1) and Schwarz rounds (2) which are increasingly used to reflect on feelings relating to clinical events.
We have come across several barriers to these groups which would have to be considered in order to successfully implement them. Firstly students and trainees often struggle to see the value in spending precious time reflecting on their feelings, thoughts and actions and assumptions. ‘Reflection fatigue’ may also have set in due to ePortfolios, work based assessments and other related activities.
Secondly, the value of these groups may not be recognised by their supervisors and senior staff, for whom reflective groups may be an alien concept.
Thirdly and most importantly, students often struggle with the dichotomy between what they discuss in their groups, and what they see in clinical practice. Whilst the vast majority of clinicians behave appropriately and professionally most of the time, all have the occasional slip up and some display downright unprofessional behaviour. Analysis of our PPGs reveals that the behaviour students notice and feel most strongly about is ‘doctors being unkind about patients and colleagues behind their backs’, as is sometimes reflected in the "heart sink patient" discussions. Students feel particularly unable to challenge this behaviour and this quickly leads to disillusionment and cynicism (3).
What are the solutions? In order to implement forums such as these for trainees and junior doctors, their value needs to be seen by senior clinical and management staff and dedicated time given over to them. They should be strongly encouraged by clinical and educational supervisors to attend whenever possible. Students and junior doctors should be given training and opportunities to discuss professional behaviour with seniors if they feel uncomfortable with anything they have seen – this relies heavily on seniors allowing themselves to be ‘challenged’ and learning how to take difficult feedback.
Senior staff are ‘role models’ whether they like it or not. Ensuring a culture of kindness in clinical practice is a powerful way to influence the professional practice of our doctors in training. Taking time out of busy clinical practice to reflect on behaviour, assumptions and motivations is crucial to achieve this. We would suggest that these forums should be made available, not just for junior doctors and trainees, but for all clinical staff – we need it.
References
1) The Balint Society home page http://balint.co.uk/ accessed 24/2/16
2) Goodrich J. Supporting hospital staff to provide compassionate care: do Schwartz Center Rounds work in English hospitals? J R Soc Med. 2012 Mar;105(3):117-22
3) Wood D. Mens sana in corpore sano: student well-being and the development of resilience. Medical Education
Volume 50, Issue 1, pages 20–23, January 2016
Competing interests: No competing interests
Re: Need for a forum where young doctors can express feelings about patients
Dr Rachel Morris and colleagues' letter leaves me - an ancient chap - bewildered.
" Professionalism lead". Role models. Kindness. Reflection.
There is a pretty simple guide: DO YE UNTO OTHERS AS YE WOULD BE DONE BY.
If the doctors do not waste time - sitting countless exams, acquiring diplomas, being revalidated, attending commissioning meetings, ticking boxes for acquiring more money - they would have more time for seeing patients, eliciting the patients' thoughts.
I know Her Majesty's Govt wants this and that. However, if the general practitioners' negotiators turned down carrots, the profession would remain a profession - instead of becoming primarily a business.
Competing interests: Old man