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‘No. Well. Yes. A little. But it’s a good thing. You don’t need to be scared. I’m glad you’re telling me this’.
My colleague was describing a particularly poor example of breaking bad news he had witnessed of someone being told that they had HIV. The doctor leading the sessions began taking notes of the incident at which point my colleague began to panic a little, not wanting to get anyone into trouble. The doctor reassured my colleague that that wouldn’t be the case and that he was glad the issue had been highlighted.
If my colleague had been from the Care Quality Commission, I’m pretty sure the bad news would have been broken in a much better way. We all put our best foot forward when we know we are on show.
It’s only when we are more comfortable that we are able to relax a little bit more, but in my opinion when it comes to breaking a diagnosis of HIV to someone, we can’t afford to relax. In health care, we all need to be on our ‘A game’ most of the time. And if not, there is a problem.
I have no doubt that the doctor to whom the incident was reported to dealt with it professionally.
After that session, I got to thinking. How many ‘incidents’ had I seen where I felt that a practitioner in question could have done a better job? More than a handful.
As a medical student we are in a unique situation. We see things first hand from an unbiased, unfiltered perspective. We move around to different hospitals at a very fast pace and people often don’t expect us when we turn up to their clinic or ward round. So, we see things as they are unplanned and unrehearsed. We often don’t know the people who we are with so are also unbiased in our opinions of them.
But how many times has a consultant asked me: ‘Did I do a good job there?’ Never. We are always giving doctors feedback on their lectures or teaching to us but never on them as doctors.
I’m not arrogant enough (and hope I never am) to think for a second that I have more medical knowledge than a consultant or a specialist. But I do know that I can distinguish a good consultation from a bad one. Irrespective of my age and medical knowledge. The same as most people can. The unique perspective that we are in as medical students is that we are seeing these interactions unfiltered and there is room for improvement.
In medical school consultation skills are now a key part of the curriculum. But some doctors have never gone through this process and I think regardless of the stage in your career, reflecting on your body language and communication skills is important. When you are a busy clinician perhaps this doesn’t rank as highly as reading the latest paper but I still think it is important.
My point is this. Medical students see the truth. And we often see things that can be improved. But we often aren’t asked. And I think we’re missing a trick here. No one is too old to learn a thing or two. Even if it does come from a medical student who is still trying to master their ECG interpretations...
Salma Aslam is a fifth-year medical student at Bristol University
Have you spoken out as a junior member of a team? Tell us about your experiences in the comment section below
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