Abstract
At the practice, we organize the day so that all the doctors can meet for a mid-morning break. A few years ago, we changed our consultation times and as this coincided with going paper light, we found that we spent increasing amounts of time isolated in our rooms not seeing each other for days on end. After a few months, we realized that we had lost the opportunity of the informal discussion we had with our colleagues over a cup of coffee. We have regular clinical meetings but the opportunity to meet and catch up on practice news and to discuss patients in an informal setting is invaluable. I am sure that a lot of your learning as a GPStR takes place in these informal settings.
Today highlighted the importance of this informal meeting. A colleague had taken a phone call about one of our elderly patients who is currently in hospital and medically fit to be discharged, whom she did not know well. However, she is becoming increasingly confused and for a number of months we have discussed her at clinical meetings as it is felt she is not fit to care for herself but she refuses to leave her home. The possibility of a mental health section has been raised but never carried through. She has recently signed a power of attorney, which implies she is fit to make her own decisions. My colleague was concerned about her discharge and wanted to discuss what others who perhaps knew her better thought. The consensus of opinion was that we could not prevent her discharge but that it was only a matter of time before she would be forced to leave her home.
The discussion raised a number of issues for me: Firstly is the importance of having an environment in which to discuss clinical care. This is very important while you are training but equally important once you start work as a qualified GP. You may work in a large practice, but without the opportunity to meet and discuss your clinical care with your colleagues you might as well work alone. For Clinical Governance, it is important that we review what we do through audit and significant event analysis, but it is equally important that we benchmark ourselves against our colleagues.
Secondly that working with a predominantly young population my knowledge of dementia is pretty rusty. It highlighted a learning need and that I really should go and read up around dementia care particularly in relation to what we can do in this type of situation. What guidelines are there on managing dementia and how practical is it implementing these in practice? What local services are available to patients with dementia? How can we as GPs or patients’ families access these services? What national support is available to families and patients with dementia? Most of this information is readily available through the Internet and although you do not need to memorize the information, you do need to know how to access it when you need it.
Lastly, last week saw the launch by the Department of Health (DH) of the National Dementia Strategy. When I heard this on the national news, I thought that I should have a look at the DH website but had not got round to doing so, mainly because it is an English initiative and I practice in Scotland. Today after coffee, I had a look at the website and discovered that the strategy is backed by £150 million pounds of investment over the first 2 years. It aims to improve dementia services in three key areas: improved awareness, earlier diagnosis and intervention and a higher quality of care through 17 key objectives. Although not addressing any of my immediate learning needs, it raised my awareness of the scale of the problem facing society in caring for patients with dementia. You as young doctors of the future have to be aware of the problem and its socio-economic consequences.