23108966There are many clinical contacts or educational events that lead to learning and/or a change in practice. You may wish to use this template to record that experience.

Some doctors find it difficult to understand what reflection is, or indeed how and why to do it. The Wales Deanery has produced a website to clarify the reflective process.

An important point to make is that as GPs we learn from patient contact – and that learning is as valuable as planned learning or attending events.

A reflective entry could look like this:-

Description of learning experience

I saw an 18 month child on a home visit OOH with abdominal pain and diarrhoea Extreme pressure from father (? Alcohol) for admission – admission arranged. Child did not require admission but social circumstances poor, father very aggressive and I had no real choice. This highlighted to me that I needed further training in dealing with aggressive patients. I have previously seen a video on this issue it was however quite low level and mainly dealt with the “office situation” where there is plenty of help on hand and indeed was aimed at receptionists.

The OOH provider was running a half day session on “aggression in the consultation and how to deal with it” so I attended. This was very valuable and in a way cathartic in that I was able to listen to others and their experiences – one GP had even had a knife pulled on them!

As a result do I need to change my current practice?

The main thing I gained was a sense of not being alone in having this type of experience and indeed that others had extricated themselves from even trickier situations.

In the workshop sessions my admission of the child was seen as a good option and put myself and the child in a position of safety – the importance of letting the paeds SHO know of the background was reinforced as was communication with the patients own GP. I did however pick up that the way in which I initially dealt with the patient probably reflected his anger back on him and possibly inflamed the situation. The father had met me at the door and said “my son needs to be in hospital and you need to admit him” I replied with something like “give me a chance to see him first” which probably set the tone. I learned that accepting and being seen to accept the patients concern may have diffused the situation and that using body language to “tone down” the aggression may be important. In the situation I had responded to the aggression with aggression.

Do I need further study or updating?

I don’t think so but I will examine the next consultation with an aggressive patient to see if I have managed to use these lessons learned.