I talk a lot about reflection, which is super important in UK practice

Dear all: I talk a lot about reflection, which is super important in UK practice. A couple of years ago, one of our doctors wrote a really good reflection about a complaint that they were involved with (the complaint wasn’t about them specifically, but involved a patient who found a procedure that was carried out on the ward very unpleasant and difficult (it was technically difficult and several of the ward juniors attempted the procedure), and complained about the whole team involved).

Where this is good quality is that it doesn’t really go intothe details such as “this was a 50 year old man who I was asked to to an ABG on” type of reflection - it’s not possible to identify the patient from this reflection and what it talks about is the doctor’s feelings about this and how it will change their behaviour in the future, which is an important part of reflection that is often done badly. With their permission, I have reproduced the reflection below to show you (the headings are from the Horus (Foundation) eportfolio headings for reflection):

Reasons for writing the reflection:

  • What were the most important things that happened/did not happen?

  • Did anything go differently than expected?

  • What have you learnt about yourself, knowledge or skills?

During this placement, I was involved in providing a witness statement & information on a complaint against the surgical team around doing a clinical procedure. Having not been involved in a complaint previously, it was initially upsetting to think that your team may have caused a bad patient experience, however reflecting on this incident highlighted some key things & lessons to be learnt. Whilst I was only involved in a short period of the patient’s care, learning from my colleague’s actions is also valuable for my own learning. The patient felt there were deficits in communication from the team, with steps and understanding not clear to her, and that her dignity was not ensured. In particular with invasive procedures, this really highlighted to myself and the team that greater care was needed to remember patient perspective, as is elaborated in my reflection below. Writing a statement allowed me to reflect on my involvement & lessons learnt, and cleared communication issues with the patient, helping her understanding and resolving the case.

Next steps:

  • How has this changed your perspective?

  • How will you apply what you have learnt?

  • What learning could you share with colleagues?

Being involved and actively reflecting on this incident highlighted to me the importance of clear communication, from my colleagues as well as myself, and the importance of explaining using terms understandable to our patients, in particular for invasive procedures. I can positively reflect that I explained the steps of the procedure and what I was doing to the patient well, ensuring consent, understanding and comfort as much as possible, however this is learning I could share and emphasize to colleagues. In my future practice I will be sure to use my reflection from this incident to ensure that I always communicate in a way that ensures understanding & empathises with the patient experience, and feel confident in reminding my colleagues & team members of this. Furthermore, it demonstrated the importance of clear documentation regardless of time pressures - on a busy shift, the importance of documentation in providing a clear timeline of patient events can often get lost, as was the case here. Since this incident, I have ensured that I clearly document persons involved, chaperones present & key steps of procedures, which will allow for clear understanding of events for both myself & other team members/ if reflection on events and patient experience is needed.

Hopefully this is helpful.