Saturday, 8 December 2012

Consultations: doing and observing

Fern unfurling
Sissinghurst, June 2012
There have been complaints. Actually, there has been one complaint. All right, it wasn't even a complaint, it was a phone call, and there was a visit too, in both of which the absence of new blog material had been noted with some concern. Mild concern. Actually, probably no concern at all, and it was nice to have a chat, and I'm glad that the cat has returned and is getting on with the other three, and everyone is doing well. And that the bees are all right at the moment, and the sheep, and the new mowing machine that doubles as a device to take out your enemies at the knees.

Latest employment news: I have been offered an interview for the job that is nearer, but with the interview still a week away at the time of writing (although maybe not at the time of publishing) I have had to seek advice from my elders and betters about what to do about the first job, the one that I have been offered subject to Criminal Records clearance and references. The advice I was given was "put your head down and keep quiet until they give you something in writing." So that is what I am doing, and they haven't given me anything in writing or even contacted me by phone or email, even though it has been weeks and I'm sure that references and CRB checks are all done. I haven't handed my notice in for my current job, so I won't be starting any new job until mid-January at least.

The interview for the newer job requires me to deliver a presentation on the challenges and opportunities of working in a multi-disciplinary diabetes team in the community. As luck would have it, I had previously arranged to spend some time this week with an experienced Dietitian working in a multi-disciplinary diabetes team in the community, so I was hoping to get her to write my presentation for me. She is much too experienced to let me get away with that one, but she did give me a few ideas that I can incorporate into the work of fiction that will be my presentation. It only needs to be ten minutes long, and I can probably keep up the pretence of knowing what I'm talking about for that length of time.

I had planned to spend the morning in the community diabetes clinic observing the Dietitian and the Specialist Nurse and anyone else who would stand still long enough for me to observe them. I did do quite a bit of observing, but just to prove that things are the same the world over, all the patients booked into the clinic turned up and the Dietitian and Nurse ran out of time, which resulted in me being asked to do a dietetic consultation with one of the patients. It was fine. I like clinics. I was hoping to go out and see some home visits in the afternoon, but there weren't any.

Watching the experienced Dietitian do her consultations was wonderful. It should be compulsory, every year or so, to sit in with someone who knows what they are doing. Managing the flow of the conversation is like directing the flow of water through sand. It is liable to change course abruptly in random directions, and the Dietitian's job is to keep diverting the stream back towards the proper destination, damming unwanted breaches of the riverbank, and eventually ensuring that the conversation and all of its tributaries reach a constructive conclusion, joining the greater body of the evidence-based ocean.

What I particularly noted was that it isn't always necessary to address everything that the patient brings to the appointment. In fact, it isn't even necessary to acknowledge some of it, and when the patient is in fact a little bit 'mental' (a technical term), then it's a very useful tactic to acknowledge only those aspects of the conversation that are relevant to the matter in hand, i.e. diabetes in this case. And I should really think a little bit more before I answer questions, but I'm not sure how I will remember to do this without a big sign in the clinic room saying 'WAIT - THINK' and it might be a bit obvious, not to say off-putting to the patient.

My own clinic has been changed, and I'm on a different day now, so I'm doing follow-up appointments for patients who were originally seen (maybe several times) by a different Dietitian. It is interesting to see how other people do things, and I've been able to report back to her about a couple of patients who have achieved really good outcomes following her advice, and have asked me to thank her. There is no difference in the mix of conditions in this clinic though - mostly IBS and obesity, with a few malnourished individuals thrown in for good measure. I even had to use an interpreter. I have also supervised a student doing consultations in an outpatient clinic, and am encouraged by a) recognising many of the mistakes the student made as being things that I did as a student, and b) being confident that I don't do them any more. At least, not often. I hope.

Last week the Diabetes UK local group had their last talk before Christmas, from a Dietitian. I missed it. I meant to go, but somehow had 'forgotten' to put the date in my diary. I think this was a successful attempt by my subconscious to prevent me from going, in order to avoid unpleasantness, and it meant that I went to badminton instead and had a good time.

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