Reflective Practice, Comfort Zones, And Mistakes.

Doc2Doc user OmarhBore posted a blog this week on the futility of the current reflective practice system for junior doctors, suggesting alternative media for reflection, including poetry, amusing musings on NHS computer screens, and interpretive dance. He felt that the enforced reflections were too contrived, and there was more to be gained from reflection than the current system allows. Reflective practice wasn’t ‘invented’ when I was a lad, or at least, it wasn’t particularly encouraged. Not that I remember, that is.

But I agree with our Doc2Doc FY-Blogger. There’s a lot to be learnt from our experiences, particularly our mistakes. And it’s easy to make mistakes – I made a mistake today – but it’s harder to talk about it, learn something from it, and move forward.

A common complaint from consultant colleagues is the feeling that we do more and more tasks that were previously carried out by more junior doctors. I’m sure I’ve ticked that box on surveys at some point. So today when I needed to write out a prescription for a patient to collect opiate based drugs from pharmacy I was in that position – doing something that is usually done by the junior doctors, and something that I’ve not done for a few years. The patient was complex, the prescription was complex, I was already thinking about the next job for the day, perhaps even the next after that, so I finished the prescription, handed it over to the nurse, and wandered off to the next task of the day.

The prescription had mistakes in it, and fortunately the nurse I gave it to realised very quickly. She caught up with me and I had the opportunity to correct the prescription. No-one likes making mistakes, least of all me, but I was relieved that she took the time to read it, and call me back.

So, I’ve reflected on it. Why didn’t I get it right? Couldn’t I be bothered? No – I want to get things right. Did I know what to do? I *thought* I remembered what to do, but I was clearly out of my comfort zone, having not written out an opiate prescription for some time. At that point, I should have asked for help, shouldn’t I? Of course I should. I spend my days teaching medical students that there’s really only one rule – Know when you don’t know what you’re doing, and know to ask for help. So why didn’t I? Why did I just scribble the prescription, and move onto the next thing in my busy day? Too many things going on? Too busy? Too proud to ask for help from someone more junior? Preoccupied, I think, with many many other tasks to do in the rest of the day, and not enough focus on the job in hand.

I had the opportunity to rewrite the prescription, and certainly the pharmacists would have called me up about it, but I was saved those blushes. When I was rewriting it, I felt suddenly very stressed. Stressed about getting it wrong again? Stressed that I got it wrong in the first place? Not sure – but stressed, for ceratin. I wonder if the juniors feel similar levels of stress when they are asked to do things outwith their comfort zone – surely they do, and surely we ask them to do this on almost a daily basis.

Come October it’ll be 20 years since I started medical school: 6 years later I was a house officer. So today, faced with something out of my comfort zone, and not stopping to ask for help, blundering on and making a mistake, only to be rescued by a nurse – I remembered very clearly what it was like to be a PRHO in 2000.

So what have I learned in those 14 years? Perhaps not enough, as I still made the mistake today, but I’ve certainly learnt that getting worked up about it, or trying to forget it, or brush it under the metaphorical rug, is not the way to move on – reflective practice makes us all better doctors. I have the opportunity to share my mistake, and my reflection on it, with a reader, perhaps an FY1 who feels stressed, or perhaps another consultant who made a mistake when rushed, and didn’t take the time required. Or perhaps it only helps me, to realise that sometimes the best thing to do is ask for help, and get it right first time.

So thanks to the nurse for picking me up on my mistake, and to OmahrBore for his poetry, and interpretive dance*. I encourage him to continue to reflect on his experiences, and particularly his mistakes, and to share them, as if only one person reads, or hears, and avoids the same pitfall in the future, it will have been worth the time and the effort – even if the person who reads it, is the person who wrote it.

I’ve kept a copy of my hastily penned prescription, and I’ll be using to teach the medical students – an example of what not to do. I’ve kept a copy of the second version, to remind me what I should have done in the first place.

*Citation needed

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