Introduction: Why is Reflection Important?
Responding to a patient telling me about their diagnosis of multiple sclerosis:
Reflection is a process of analysing an experience and evaluating one’s actions during the event or considering the effect the event may have had on the individual. It is critical in improving medical practice as it enables clinicians to learn from mistakes, advance their skills and assess their personal wellbeing. Since reflection enables improvement, it is an integral feature of lifelong learning, a key component of a career in Medicine. It also improves the ‘quality of care for patients’ (MDU 2022) and in this way can aid the doctor-patient relationship. Without reflection, mistakes may reoccur or ‘remain disjointed and worthless’ (Artioli 2021) since changes to improve systems will not be implemented. The process of reflection allows doctors to critically analyse their performance of practical skills, communication with patients and interactions with colleagues. Reflective practitioners are therefore able to identify current flaws in their work and seek improvement. In this way, reflective practitioners are more committed to improving patient care. Doctors who reflect regularly may be more inclined to assess the situation from the patient’s perspective, making them more empathetic and further enhancing the patient experience.
Description:
When attending a research trial investigating multiple sclerosis, I followed a patient during their tests. We discussed their condition and diagnosis but I realised that my response may not have been appropriate when the patient said to me, “Don’t look sad”.
Feelings:
I felt embarrassed as it felt as though the patient was providing me with more support than I was giving them. I felt ashamed for not knowing how to react without seeming nonchalant whilst trying to remain positive. However, I was grateful to the patient for their honesty about their diagnosis and the effects the condition has on their daily life which facilitated my understanding of disease on a patient.
Reflection:
On reflection, I’ve realised that it can be difficult to respond to bad news in the ‘right’ way and it may vary depending on the patient. My lack of experience in knowing how to respond appropriately resulted in the patient feeling emotionally unsupported. This has made me aware that as a clinician, my response to a patient’s situation will influence the doctor-patient relationship. I’ve learned that even small interactions with patients can have a big impact on their confidence in a clinician. I now recognise that I must empathetically conduct myself as a clinician whilst maintaining a professional distance.
As a future doctor, how can I best respond to a patient who is confiding in me? How can I prepare myself for these conversations?
Conclusion:
Researching risk communication, I was interested to find that clinicians may work with their patients to set goals such as ‘influencing mindset’ (Romy Richter 2020). Reflecting on this highlighted that the ethical pillars of autonomy and beneficence may conflict during risk conversations. It is important to explain the extent of risk to patients to give them autonomy but if this information increases their anxiety causing detrimental health impacts, doctors may be indirectly causing harm. I have realised that whilst it is important to be open with patients about risk, steps should be taken to minimise their fear.
Further reading highlighted the challenges faced by patients such as the ‘heavy financial impact’, exacerbated for rare diseases where there are ‘inequitable hurdles’. As a clinician, there is also ‘difficulty in maintaining confidentiality… because of the rarity of their conditions’ (Hartman 2020).
In the student BMJ (Michael W. Rabow 2000), I read an article describing methods to help with difficult discussions and breaking bad news. I feel that these techniques could be applied when responding to a patient, especially allowing time for silence. This could have been a good response in the situation as it would have enabled the patient to feel listened to and alleviated some of the tension I was feeling, by giving me more time to think of an appropriate response. As well as this, it is recommended to prepare emotionally. I had not been expecting to talk with a patient individually so I was unprepared for my conversation and had not primed myself emotionally.
My Advice To You to help you get into medical school
- Implement the technique of leaving time for silence when in communication skills sessions so that when I am talking to patients in a clinical setting, I am not distracted by silence.
- Practise preparing for difficult conversations emotionally beforehand; I will visualise the conversation and imagine how I will feel in response to sad news so that the feelings I experience during the conversation are not a shock to me.
- Give patients information necessary to make an informed decision whilst being careful not to increase their anxiety unnecessarily by working with them to shape their outlook.
References:
Artioli, G., Deiana, L., De Vincenzo, F. et al. . 2021. Health Professionals and Students’ Experiences of Reflective Writing in Learning: A Qualitative Meta-Synthesis. Available at: https://bmcmededuc-biomedcentral-com.abc.cardiff.ac.uk/articles/10.1186/s12909-021-02831-4 [Accessed 2/03/23].
Hartman, A. L., Hechtelt Jonker, A., Parisi, M.A. et al. 2020. Ethical, legal, and social issues (ELSI) in rare diseases: a landscape analysis from funders. Available at: https://www-nature-com.abc.cardiff.ac.uk/articles/s41431-019-0513-3 [Accessed: 02/02/23].
MDU. 2022. Quck Guide to Reflective Practice. MDU: Available at: https://www.themdu.com/guidance-and-advice/guides/quick-guide-to-reflective-practice [Accessed: 2/03/23].
Michael W. Rabow, S. J. M. 2000. Beyond Breaking Bad News: Helping Patients Who Suffer. Available at: https://www-bmj-com.abc.cardiff.ac.uk/content/320/Suppl_S3/000365 [Accessed: 15/01/23].
Romy Richter, E. G., Jesse Jansen, Trudy van der Weijden. 2020. A Qualitative Exploration of Clinicians’ Strategies to Communicate Risks to Patients in the Complex Reality of Clinical Practice. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236751 [Accessed 15/01/23].
