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Communication, Culture and Conflict
Dr Celia Gregson
Specialist Registrar in Elderly and Internal Medicine
Frenchay Hospital, Bristol
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Pitfalls
Culture
Language
Dress Code
Working Conditions
Hierarchy
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Stereotypes
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How you see us….
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How we see you….
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Dress Code
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Dress Code
No JeansNo BirkenstocksLeather Shoes, closed toeSmart trousers, skirtShirt / blouseTieWhite coats?Name badge‘Naked from the elbow down’
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Language
Video clip Coastguard.mpeg
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Communication within the NHS
Patients / families / carers
Nurses
Team members (PRHO, F2, SHO, SpR, Consultant)
The MDT: Physios, OTs, Social workers….
Discharge and referral letters
Breaking bad news
SOH
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Communication with Patients
Introduce yourself
Explain management
Ask for consent
Consent forms
Chaperone
Involve in decisions, provide options – AUTONOMY
Non-paternalistic
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4 Principles of Good Medical Practice
1. Non-maleficence
2. Beneficence
3. Autonomy
4. Justice
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Resuscitation
DNAR
2222
Treatment vs Choice
Autonomy
The Form
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How to talk the talk…
To ‘open your bowels’‘Down below’‘Privates’ / ‘private parts’LMP – last menstrual period‘Bloating’To ‘Pass wind’Nauseous and Nausea and NauseatedVomit, to be sick, to ‘throw up’‘Waterworks’Examine the ‘back passage’
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‘Doctor I’ve lost a stone!’
1 Stone = 14 Ibs = 6.35kgs
1 Ib (one pound) = 16 ounces = 454g
1 ounce = 28.35g
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How tall are you?
‘Five eleven’Five foot and eleven inches5’11
1 foot (ft) = 12 inches = 30.48cm1 inch = 2.54 cm
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So….
I’m 5’3 and weigh 9st 5
…..what’s my BMI?
My baby weighs 7lbs 7oz…..
What does this all mean?
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Another one…‘How far can you walk on the flat before you get out of breath?’
‘Oh, about 200 yards’
‘Oh about half a mile’
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Communication with nurses
Never underestimate the power of a nurse and the impact they can have on your QOL!
Grades A-G
Teams
Sister i/c
Specialist nurses / nurse practitioners
Bed managers
Nurse
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Communication with GPs
On the phone Taking referrals Giving advice Discharge planning Seeking information
Via letters Succinct Polite Normal language Copy to patient? –
policy?
CRUCIAL – Interface between primary and secondary care
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Working Conditions
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Wards
Long Nightingale wards
Curtains
Bays
Notes & stickers
Notes trolleys
Team based vs ward based
Phlebotomists
Ward clerks
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The Medical Team
Consultant
Specialist Registrar - SpR
Senior House Officer – SHO
Foundation Year 2 – F2
Pre-registration House Officer – PRHO / Foundation Year 1 – F1
Medical Students
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Documentation
Clerking – routine / oncall / proformas
Investigations
Blood results
Ward rounds
Referrals to other colleagues..
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Dear Urology SpR
Thank you for seeing this charming 83 year old retired ventrioquist. He has had prostatic symptoms for 8 years, latterly with nocturia x 5. He has an irregular feeling prostate and a PSA of 12. Calcium, ALP and clotting are normal. No bony pain. MSU clear. Dr Bloggs would greatly value your assessment. Thank you.
Dr Under-Bloggs 1749 SHO to Dr Bloggs
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Ward round
Meet the team
Consultant lead
Present new cases
List of patients and their whereabouts
Write in the notes
Record necessary investigations
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Ward Round NotesDate
Time
S
O
A
P
27/03/06 WR Mr Sharpknife
09.10 am day1 post appendectomy
Lydia well in herself
obs stable, apyrexial
O/E: abdo soft, nontender, BS present
IMP: Recovering well
Plan: Stop ivi, eat and drink, cont Abs total 2/7
Little SHO 2273
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HandoverWorking the shift system Hospital at Night
Large numbers of patients
Document instructions clearly in the notes
Make plans for the weekend
List all critical patients
Reviews and by whom
Investigations to be checked
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Communication with colleagues
ESSENTIAL
Be professional
Be polite
Listen
Do not be afraid to ask
Positive feedback
Keep your sense of humour
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Teaching
Grand Rounds
Journal Clubs
Departmental meetings
Xray meetings
Your colleagues – teach and be taught
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Do you know….
Time to get competitive…..
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NHS & medicine
What is the name of this British GP andwhat is he famous for?
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British Sports
Which competition is this and who is this?Other than his sport, what is he infamous for?
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British cinema
Name this actor and his role – arguably the most famous figure in British cinema?
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NHS & medicine
What is this man infamous for and whatis his name?
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British CuisineWhat is the name of these two famous British dishesand which one is always served on Friday in Britishhospitals?
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British Television
What is the name of this British comedy
figure and what is she famous for?
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British Landmarks
Where is this street located and do any of you
ever think you’ll work here?
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Celebrities
What is the name of this famous couple?
What are their nicknames?
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Last but not least..Who is this and what’s she responsible for?
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Any Questions?