Don's diary

July 16, 1999

Monday

Last week patients consulting doctors in bizarre or unusual circumstances was a theme of one of the courses I teach. One GP taking part in the "reflective practice" session wrote about patiently waiting in the supermarket queue, when the assistant, instead of scanning his beans, hoisted her leg onto the checkout, saying loudly: "Oh

doctor I'm so glad to see you, just take a look at my ulcer will you."

Another wrote about having to be a doctor on holiday: checking over a young man severely brain damaged after a fall on the Fells. I never know what GPs (or consultants or nurses) will write about, which areas of practice will prove to be the ones that they pressingly want to reflect on.

Tuesday

Overheard a nurse moaning: "Oh reflective practice: all those boring questions about how I could have done it better." He looked far from bored later: hearing and discussing peers' stories about issues troubling, perplexing or irritating them. Reflective practice, an essential element in medical, nursing and other

professional education, combines an explorative, expressive

writing method with carefully facilitated interactive group-work. It is used as part of

continuing professional

development courses, masters degrees and training for clinical supervisors.

Wednesday

Shouting at a patient with addiction problems in the waiting room after all the other patients had left, was one story tonight. The GP said she felt a great deal better afterwards and the patient behaved much better for some time. The group was relieved to discuss how some patients trigger emotional reactions that they feel guilty about. One told us how he now copes much better with his feelings when child patients die. Writing a poem and talking for the first time last year about the death of his brother has made a great difference.

Clinicians reflect upon a range of issues as wide as medical

practice itself. This reflection is given depth, cogency and a clear focus by being initiated by written stories - not properly plotted, but chunks of life written for a group.

Thursday

"Can't we just tell our stories?" a nurse asked. Writing is different from talking - it fosters exploration. Perhaps because it is private - a piece of paper will not be horrified or disgusted. Once written it is easier to read and share the experience - a staged process; and despite fears, peers always respond with support, suggestions and empathy.

Saturday

Just used the reflective practice method co-running a two-day seminar at the British Medical Association, for 40 health professionals, to examine decision-making in critical situations. It would be appropriate with any profession; doctors are not the only ones whose lives are stories waiting to be written and explored.

Sunday

Wrote a poem about beekeeping.

Gillie Bolton is research fellow in

medical humanities at the Institute of General Practice, Sheffield University.

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