Trainee blunders
YouTube:
During the medical consultation, the experienced family doctor, Dr Smith, is accompanied by a junior doctor, Harris, who is currently undergoing vocational training to learn about general practice as part of their medical education. It’s important to note that Harris is not just an observer but an active participant in the consultation under the guidance of Dr. Smith. Mrs Gainworth, a concerned mother, walks into the office and is visibly upset to see a third person in the consulting room. The doctor warmly greets her and asks how he can be of assistance. Mrs Gainworth then begins to share her worries about her son, John, who we later find out during the consultation, has Down’s syndrome, and consequently, she is seeking advice about specialised schooling options for him.
Firstly, Mrs Gainworth is expressing dissatisfaction with the quality of education her son receives. She has complained about disorganisation and the need for more effort to teach the children effectively. Furthermore, the school relies on giving the children numerous exercises to tire them out. Additionally, she is concerned that the other children’s unruly behaviour negatively influences her son, John.
We first learn that John has Down’s syndrome when the doctor hands over his notes to Doctor Harris, the junior doctor in training. The doctor then provided Mr Harris with some background information about John’s condition. Mrs Gainworth, John’s mother, subsequently expresses her concerns about the situation and explains that the current school doesn’t provide adequate education for children with special needs. She requests the doctor’s assistance in finding a new school for John, as she believes the current one focuses too much on physical education and neglects academic instruction. Mrs. Gainworth firmly believes that her son, John, is capable of learning, as she has been actively teaching him at home.
Children have lots of energy.
The doctor explains that these children have a lot of excess energy, which may be why they are so active. Then, the trainee interjects with a well-meaning comment that exercise might not suit the child due to their congenital heart condition. It’s important to note that when discussing age-related issues, sensitivity and tact are crucial. The trainee also notes that this issue has been carefully avoided until now. Doctor Harris then unwittingly remarks on the patient’s age, saying that she must have been quite old when she had her son with the congenital heart condition, which prompts the horrified question, ‘What does age have to do with it?’
During the consultation, several issues were raised regarding the difficulties that can arise when a third party is present during a medical appointment. It’s crucial to prioritise patient comfort and address any unease they may feel when discussing personal or intimate matters in front of an unfamiliar individual.
In addition to the training points previously mentioned, it is advisable to brief trainees in advance on the nature and unique circumstances of a problem before the patient arrives. Providing prior information in the form of notes will give them context and help them better understand the situation, ensuring they are prepared and knowledgeable.
Furthermore, it is essential to note that while it can be beneficial for young doctors to interject with comments and questions during the consultation, this verbal input should only be done in certain situations. It is crucial to assess whether their input will contribute positively to the patient’s overall care, demonstrating responsibility and consideration.
Some additional teaching points to consider are:
– Briefing trainees in advance about the nature and unique circumstances of a problem before the patient arrives.
– Noting that it is only sometimes beneficial to have young doctors interject with comments and questions during the consultation.