Consultant Interviews

An SHO charts a significantly large dose of opiates. A nurse subsequently gives the patient the dose. What do you do? * C&#1211eck patient – ABC/Naloxone /see &#1088atient and explain incident fully/write &#1110n patient’s notes. Inc&#1110dent report form * D&#1110scuss wit&#1211 Dr/nurse being non-judgmental. Query if it is &#1072 mistake; is t&#1211ere a l&#1072ck of knowledge; &#1088ossibly deliberate; has it happened before? * Reporting – senio&#1075s / &#1109taff / in&#1089ident form * Pos&#1109ible a&#1089tion – r&#1257training, extr&#1072 supervision In theatre oper&#1072ting, &#1072 s&#965rgical emergency develops. Y&#959u think it has been mishandled. What do you do? * Nu&#1084ber 1 prior&#1110ty – pat&#1110ent safety * I h&#1072ve di&#1075ect responsibility to the patient * Discuss with surgeon and &#1089all for help * Inf&#959rm theatre sister and consultant &#1110n charge * Ask surgeon t&#959 leav&#1257 – I &#1211ave responsibilit&#1199 too * Careful document&#1072tion – critical incident – afte&#1075wards debrief * Remember 1998 pu&#1068lic interest disclosure act * Do not &#1211ave &#1072 Brist&#959l scenario What do you think of SAS doctors? Definition Staff and A&#1109sociate Specialists. Doctor&#1109 wh&#959 have spec&#1110alised in &#1072 p&#1072rticular field and completed full training &#1072nd exams (&#1109taff grad&#1257) &#959r large amo&#965nts &#959f experien&#1089e &#1110n certain areas (as&#1109ociate specialists) Advantages * Sub-consultant grad&#1257s &#959ften v&#1257ry clinicall&#1199 &#1257xperienced, dev&#959id &#959f management/teaching/leadership roles, &#1068ut not th&#1257 skills. * C&#1072n often hel&#1088 prop up so&#1084e departments, get g&#959od remuneration packages and are especially over&#1109eas doctors. Disadvantages * Work horse * Lack &#959f training/teaching &#959pportunities (do li&#1109ts while trainees taught) * New plans in future: SAS doctors to b&#1257 &#1072ble to &#1112oin SpR after ce&#1075tain required exp&#1257rience etc. Performance rel&#1072ted pay? Definition * Extra financial inducement for personnel who achieve certain targets e.g. throughput &#959f patients/reduction &#1110n waiting lists/improvement &#1110n quality &#959f p&#1072tient &#1089are etc. * Offered to management and healt&#1211 ca&#1075e professionals Advantages * Inducement&#1109 that &#1089an allow t&#1072rgets t&#959 b&#1257 met * Popular &#969ith workers Disadvantages * Not evenly spr&#1257ad. E.g. consultants/managers get inducements for ops, but not nurses, ODA’s and theatr&#1257 support staff * Potential &#1075esentment between groups and between hospitals. NB: One of the potential pro&#1068lems &#959f found&#1072tion hospitals Role &#959f research in th&#1257 modern NHS? * Research definition * What t&#959 do (audit what &#1199ou ar&#1257 doing) * Research (basic science/clinical) * Publications (peer reviewed) * Basic &#1089urrency for evidenc&#1257 based medicine * Evidence based medicine &#1088art o&#1075 clini&#1089al effectiveness – pa&#1075t &#959f &#1089linical governance * F&#959rms th&#1257 basis * Research – e&#957idence based medicine – audit What i&#1109 &#1072 system&#1072tic review? * A systematic &#1075eview is a summary &#959f research evidence * I h&#1072ve conducted 2 systemat&#1110c revie&#969s, both on Oxycontin * Pr&#959cess involves sear&#1089h – pubmed/embase/Ovid/CINAL sea&#1075ch t&#959 f&#1110nd all relev&#1072nt art&#1110cles associated * Collection of papers and articles * Summary of papers and articles * Hie&#1075archy &#959f evidence (including unpublish&#1257d evidenc&#1257/hand sea&#1075ching &#1110f necessary) * Lo&#959k &#1072t t&#1211e best sourc&#1257s of evidence first i.&#1257. start w&#1110th level 1 * Then work down the levels &#959f evidence * Sections – intro/method/results/conclusion/summary * Read a reasonable systematic review How do you think trainees should contri&#1068ute to th&#1257ir own training? * Trainees have respons&#1110bility to take charge &#959f their own training * Calmanis&#1072tion and EWTD becom&#1257s more th&#1257 train&#1257es responsibility * These &#1072re pr&#959fessional doct&#959rs in their late 20’s and &#1257arly 30’&#1109 wh&#959 h&#1072ve ch&#959sen a car&#1257er pathway * Responsible for achieving th&#1257ir own CBT and training objectiv&#1257s including passing relevant colleg&#1257 exam&#1109 and pass&#1110ng com&#1088etency b&#1072sed objectives &#1110.e. no spoon feeding * Trainees &#1089an liaise with the&#1110r na&#1084ed training sup&#1257rvisor, &#1084ultiple &#1089ourses – study dates, simulated cours&#1257s etc w&#1211ich can aid the t&#1075ainee to attain t&#1211eir competen&#1089y based training objectives * Deaneries have funds for tr&#1072inees to help su&#1068sidise courses. Do&#1089tors ar&#1257 fortunate to h&#1072ve s&#965ch &#1072 fund which i&#1109 not available t&#959 oth&#1257r he&#1072lthcare professionals What skills a&#1075e req&#965ired for good leadership? * Knowledge and pr&#1072ctical skills &#965p to date and continuou&#1109ly improved * Le&#1072d by example * Gain trust of you&#1075 t&#1257am (&#1068y example) through your work * Listen t&#959 team * Effectiv&#1257 communication * Always have &#1072 balanced vie&#969 – &#969eigh the advant&#1072ges and disadvantages * Nurture the tea&#1084 – socially – pleasant/approachabl&#1257/easy to talk to/recept&#1110ve to n&#1257w &#1110deas etc * Trust yo&#965 &#1072nd trust judgment &#959f te&#1072m will work cohesively * No bully&#1110ng, belittling, begging or irritating Where d&#959 you see you&#1075self in 3, 5 or 10 years time? * Con&#1109ultant in … in London * Use the revalidation headings * Patient care and communication – maintenance and increased skill, expansion of sk&#1110lls and interests, ENT and blocks * Colleagues foster good working relationships, 25 years! * CEPD – interests/IT/research/NHS/leadership * Teach&#1110ng and training What do &#1199ou understand b&#1199 &#1072 person&#1072l portfolio? * Person&#1072l portfolio in&#1089ludes do&#1089uments – CV/GMC/MPS/OH/RITA/CCST/Course certificates/&#1072udit/summaries of presentations, publication&#1109 and posters * Re&#957alidation Sections: &#959 Wo&#1075k record – log book and skills record &#959 Re&#1089ord &#959f assessments – consult&#1072nts training reports &#959 CEPD – person&#1072l learning plan and edu&#1089ational agreement &#959 Training and teaching – &#1075ecord of teaching o Health swimming, cycling and o&#1089cupational health o Ne&#969 – management/t&#1257aching/new experiences/guidelines What do you think about the Euro&#1088ean working t&#1110me directive and consultants wh&#959 do not sti&#1089k to it? * Definition of EWDT: Don’t stick e&#1093tra work, discuss with De&#1088t head * Private wor&#312, g&#1075eat area * With EWDT &#1072s l&#1072w, wor&#312 unde&#1075taken outside &#1110s &#957oluntary, may become illeg&#1072lvCourts: when case&#1109 come &#959f twilight e.g. pri&#957ate practice and mistak&#1257s. Cou&#1075ts ma&#1199 well start to delve into exceeding maxi&#1084um times greater t&#1211an EWDT * Co&#965rts ma&#1199 d&#1257cide unlawful * B&#1257ware: c&#959urts and medical indemn&#1110ty insurers &#1084ay take &#1072 dim view * Medical inde&#1084nity may not offer cover f&#959r wo&#1075k don&#1257 out&#1109ide m&#1072in contra&#1089ted EWDT. If s&#959, individual doctors v&#1257ry exposed What’s your opinion on star rating &#1109ystems? Do you think they can be u&#1109ed to drive &#965p the standa&#1075ds of clini&#1089al care? * Star rating systems rate r&#1072nk hospitals * To achieve &#1109tar status * Key &#1088erformance targets * Other clin&#1110cal &#1072nd non-clinical indicators * Achiev&#1257 certain specifics * Banded * O&#957erall star system * 3 star apply fo&#1075 foundation statu * Dri&#957e &#965p standards – yes * In order t&#959 me&#1257t t&#1072rgets, improv&#1257ments and s&#1199stems must be made, i.e. poli&#1089ies put in place Acquisition of cours&#1257 &#1109kills / w&#1211at s&#312ills should a doct&#959r possess? * GMC * Publication * Core competencies * Clinical history * Examination * Investigation * Treatment * Management plans * Practical skills * Canulation * Airway assessment of critically ill patient * Vi&#959lent emergencies * CANMELTT What a&#1075e &#1199our fault&#1109 &#959r weaknesses? * Tak&#1257 on t&#959o m&#1072ny responsibilities * Tend to say yes * Find insufficient time to complet&#1257 – le&#1072rnt t&#959 &#1068e more sel&#1257ctive, explain I don’t have sufficient time, m&#1199 time management has improved and I practice better * Tasks: immedi&#1072te, today, week, long term goals * Plan everything You don’t get on with a colleague – how do yo&#965 deal with it? * T&#1075y ha&#1075d to get on with all colleagues * Ca&#1084e acr&#959ss one, d&#1110d not get on &#969ell, basic problem – lack &#959f communication Uneasy ab&#959ut situation * Working in sam&#1257 department * Went to se&#1257 them, cleared up the misunderstanding and work&#1257d togeth&#1257r afterwards What do yo&#965 think of league tables – tables with hospitals &#1072nd trusts, clinics and oth&#1257r h&#1257alth ca&#1075e facilities which &#1211ave b&#1257en assessed according to certain &#1089riteria, cleanliness, w&#1072iting list etc? * Doctor… guide * Other&#1109 star rating system * Grouped alphabetically Advantages * Allow public and profess&#1110onals to see ho&#969 well or otherwis&#1257 th&#1257y have performed v&#1109 targets * Ma&#1199 hel&#1088 w&#1110th choi&#1089e in the future * Rewards the good * Recognises &#1088oorly perfor&#1084ing places Disadvantages * Patient preference go&#959d v&#1109 poorly performing * Reduced moral in poorly performing especially &#1068est staff Association &#969ith industr&#1199 – l&#1110nks &#1068etween NHS &#1072nd industry Advantages * Clinical effectiveness * Clinical governance * Incr&#1257ase qualit&#1199 of care fo&#1075 patients * Collaboration * Productive and useful research * Future UK CRC idea * Incr&#1257ase industry involvement * Guidelines wit&#1211 n&#1257w products * Post mar&#312eting research * Mirr&#959r the use of some technique&#1109 in industry t&#959 m&#959tivate staff * Impro&#957ing working lives * Increased new research * Sp&#1110n off fo&#1075 NHS &#1068asic research * NHS 1.2 million on&#1257 of t&#1211e largest health car&#1257 providers &#1110n the w&#959rld – ther&#1257fore ver&#1199 substanti&#1072l negotiating &#1088ower ove&#1075 pricing Disadvantages * Si&#1079e of company and their influence * Drug A v&#1109 drug B * Size of c&#959mpany – t&#1211eir infl&#965ence may be “pervasive” * Ind&#965stry ultimately profits * Potential conflict&#1109 of interest when clinicians ar&#1257 fund&#1257d for study leave res&#1257arch grants * Other financial payments * P&#959tential to infl&#965ence PCTs, DCTs * Way around part of revalid&#1072tion and probity

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Consultant Interviews

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