Self Care Workshop RNZCGP Conference 2018 - Dr Caroline Christie
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Self Care Workshop
RNZCGP Conference 2018
Dr Caroline Christie
INSERT PIC HERE Pegasus Health Small Group Education
Conventional CME/CPD
Pros: Cons:
• Tried and true • Not always balanced or evidence based
• Up to date • Risk of industry bias
• Little preparation required by organisers • Secondary care perspective predominates
• Cheap • Weighted to new & relatively untested
• Presenter often able to field peripheral technologies
questions in specialist area • Tends to be didactic
• Good for “updates” • Often unidisciplinary
• Encourages primary/secondary care • Often different audience each time
communication • One presenter, many learners
• Limited ability to interact
• Little learner ownership
• Unlinked to learner utilisation
• Little time for learner experience
Philosophy and hypothesis
“The promotion of “Doctors will practice
best clinical practice rationally if given
with optimal and independent
ethical use of finite evidence, feedback,
resources” the opportunity to
discuss with peers
and appropriate
incentives”Underlying principles • Peer led – discussion, comparison of practice • To promote evidence-informed best practice • Current, topical issues • Independent • Primary care team focus • Informed by prescribing & laboratory utilisation • Outside the comfort zone
Education themes • Supporting best practice • Addressing polypharmacy • Understanding variation in practice • Encouraging shared decision making • Considering health literacy
Ongoing evolution
• GPs 23 years
• PNs 18 years
• CPs 6 years
• NPs 1 year
Promotes teamworkGathering evidence • Comprehensive literature review • Critical appraisal and grading of evidence • Communication with specialists • Consultation with interested parties • Collation of information
Take home messages • Small group education is peer led, evidence- informed, interactive and teamwork based • SG education has evolved to become tailored to the needs of both clinicians and patients • It is interesting as it tends to look at grey areas and variation
[Pixabay 2016] Multidisciplinary Small Group education - Nov/Dec 2016 Self-care: surviving the silly season
Acknowledgements
This material was prepared by the Clinical Quality and Education team with help
gratefully received from:
Topic preparation team
• Susan Tarnay Small Group Leader, GP
• Jeanette Hight Small Group Leader, Practice Nurse
• Louise Kennedy Small Group Leader, Community Pharmacist
Others consulted
• Vince Barry CEO, Pegasus Health
• Simon Wynn Thomas Senior Clinical Leader, Pegasus Health
• Sue Zorn Management Services Coordinator, Pegasus Health
• Brendan Sillifant Mental Health GP Liaison Counsellor
This clinical resource was prepared by the Clinical Quality and Education Team, Pegasus Health. Any statement of preference made is a
recommendation only. It is not intended to compel or unduly influence independent prescribing choices made by clinicians. References not
listed are available on request. All clinical documents produced by Pegasus Health are dated with the date they were originally produced or
updated, and reflect analysis of available evidence and practice that was current at that time. Any person accessing any clinical documents
must exercise their own clinical judgment on the validity and applicability of the information in the current environment, and to the individual
patient. The educational material developed for delivery at this education session remains the intellectual property of Pegasus Health. This
material is not to be redelivered, on sold to any individual or organisation, or made publicly available on any website or in any publication,
without written permission from Pegasus Health (Charitable) Ltd. Pegasus Health (Charitable) Ltd November 2016Setting the scene
“These are the duties of a physician:
First to heal his mind and
to give help to him-self
before giving it to
anyone else”
From the epitaph of an Athenian doctor, 2 ADWhilst attending a social
function, a friend asks you for
medical advice.
What do you say?Q13: Do you give medical advice to friends, family
and/or neighbours socially in lieu of them attending
their own GP/health professional?
Yes
No
I try not to but sometimes
it’s hard to avoid
[From “All data”]Prescribing to family or friends
Ask yourself:
• Am I able to provide appropriate medical care?
• Am I following my usual practice?
• Would my peers agree?
• Does this mean my family member/friend is now my patient?
• Would our relationship survive an adverse treatment outcome?
Only prescribe in exceptional circumstances
[Bird 2016]Boundary issues outside work • Have you ever used medications or medical supplies from your place of work? • What are your obligations if asked to assist in an emergency?
Boundary issues at work • Treating staff in your practice – Do you have a practice policy? • How do you deal with pressure from staff or patients? – More difficult for some personality types than others – Work as a team re early pickups and documentation
Sick day trends
• 504 responses (from GPs, NPs, PNs, CPs)
96% are enrolled with a GP
48% consulted a colleague rather than their own GP
• In past 12 months:
– 59% of GPs took no sick leave; 53% worked when they knew they shouldn’t have
– 48% of NPs took no sick leave; 37% worked when they knew they shouldn’t have
– 28% of PNs took no sick leave; 55% worked when they knew they shouldn’t have
– 46% of CPs took no sick leave; 64% worked when they knew they shouldn’t haveQ7: If yes, please specify the reasons why you
kept working (check all that apply)
To maintain personal privacy
about illness
Too busy to take time off
Couldn’t afford to take time off
Didn’t want to let colleagues
down
Didn’t want to let patients
down
Wanted to avoid stigma of
being ill
Other (please specify) [From “All data”]How does having medical knowledge affect you as a patient?
How does having a patient with
medical knowledge affect
how you practise?Why do errors occur? Everyone makes mistakes - the trick is to learn from our mistakes so they don’t happen again What processes do you have to evaluate errors?
How would you recognise
substance abuse in a colleague?
How would you help this
colleague?Time to reflect
Have you reflected on your
own alcohol consumption
lately?
Is it within guidelines?Is your bucket full enough?
Recuperation – rest, recuperative sleep, relaxation, healthy nutrition, good health,
interesting, stimulating and rewarding work, supportive friendships and family, etc.
Effort – excessive or Personal - illness, pain,
The bucket
insufficient intensity and disturbed circadian rhythms,
of personal
or duration of physical resources sleep loss, poor nutrition,
and mental effort inadequate exercise
Environmental - demanding or Organisational - demands of work
hazardous environment: climate, including shift work (especially badly
noise, ergonomics, etc. designed shift work)
Emotional demands – conflicts,
responsibilities, worries [The bucket model of fatigue,
OSHS 2003]Mindfulness Mindfulness is a way of taking notice to foster clear thinking It involves being ‘mindful’ not ‘mind full’
Do you feel supported?
• 86% of HPs felt adequately supported
• 43% of HPs sought professional support for self-care
– 88% of these from own GP
– 13% of these from counsellor or psychologist
• Adequate locum cover is needed
[From “All data”]
(Figures add to >100% as some people consulted more than one type of professional)What support is available?
Continuing PHO
education (pastoral Your GP
care)
Professional
bodies Workplace
Peer
support,
Psychologist, Family &
mentors, counsellors
Balint friends
groups
Cultural Online
groups supports
Please seek help if you have concerns about your ability to practice safelyWill you be making a New Year’s
resolution in 2017?Take home messages
• See your own GP; take sick leave if needed
• Keep a good work-life balance
• Maintain an effective professional support network
• Join Pegasus Small Group Education
• When treating HPs as patients, give as much information as
you would to any other patient
• Look out for your colleagues
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