I escaped the rock recently and spent the long weekend in Brisbane. In addition to the usual mainland activities (eating out, shopping, attending the local cinema and more shopping), I attended the RACGP Qld Clinical Update. I often come home from conferences feeling reinvigorated and inspired, but I never end up collating or organising my notes and ideas into anything intelligible (let alone useful). This year, IslandDocs has motivated me to share some take home messages from the conference, as well as a few clinical pearls that will likely change my practice (and hopefully will be useful for you as well).
My favourite take home messages
Geoff Toogood is a brave and inspirational man (and cardiologist), who I could have listened to all day. He shared his personal journey dealing with depression and anxiety and he highlighted a few things that resonated with me:
- We need to get better at looking after ourselves and our colleagues
- We also need to normalise the conversation about doctors’ mental health
- Essentially our culture needs to change and it’s up to us to change it – our own lives depend on it
John Buckley urged us to use our everyday GP toolkits to overcome challenging consultations in general practice. Our strengths lie in our interpersonal relationships with our patients, our skills in interpreting medical knowledge and our resources (both physical resources as well as our colleagues). Our empathy is one of our biggest weapons and our ability to see patients over time is a wonderful gift. Having said all of this, challenging consultations can get us down, so building resilience and looking after ourselves is just as important as (if not more important than) what we do for our patients.
Things that will change my practice
A big thank you to Ben Mitchell for reintroducing me to Dynamed, an evidence-based clinical reference tool that is freely accessible via the RACGP library. I’m going to use Dynamed more often during my consults for the following reasons:
- Evidence based guidelines – great for double-checking diagnostic criteria and management guidelines
- History and examination sections can reinforce points that you might have missed in your own consultation and can help you to be more thorough
- Differential diagnosis lists can help you to broaden your differentials and remind you to think about conditions that you may have otherwise left off your list
- Good lists of patient handouts
Bite Back: online mental fitness challenge
Jan Orman recommended this one. Think of it as a 6 week resilience training program for teenagers. Check it out here : https://www.biteback.org.au
Car analogy for self-care
Vicky Dawes and Anne Ulcoq’s car analogy could be easily translated to our patients as well as be applied to ourselves. Imagine you are a car. Think about what cars need to stay in good condition and perform their function well. It’s not that different to humans!
- Battery (psychological/physical energy) – What is draining your battery (eg. work, stress, hungry)? How can you recharge the battery (eg. Pauses at work, hobbies outside work)? How are you going to make this happen?
- Load (multiple demands, stressors, commitments) – How much are you towing? If you’re towing too much, can you deal, delegate, and/or decline?
- Driving (inner voice) – Are you being too critical? Remember to treat yourself the same way that you would treat others
- Annual service (care of your physical & mental wellbeing) – See your GP for a check up. If we don’t schedule it in, we risk the wheels falling off.
- Driving conditions (extrinsic factors outside our control) eg. Work: admin, red tape, bullying, exams, on call eg. Life: kids, marriage, divorce, illness, death
- Dashboard warning lights (self-awareness of early warning signs) Do you know your early warning signs? Do you need to recharge your battery?
Resources for managing domestic violence in general practice
Some GPs find these consults confronting and challenging, so I hope Clare Maher’s list of resources will help others:
- RACGP White Book Guidelines (includes tools for problem solving & motivational interviewing)
- Websites: https://www.1800respect.org.au & https://www.dvconnect.org
- Apps for patients: Daisy, PENDA
- GP toolkit: http://www.wlsnsw.org.au/gp-toolkit/
- Webinar: Working with victims of family abuse & violence: looking after yourself: https://www.racgp.org.au/education/courses/faculty-webinars/national/working-with-victims-of-family-abuse-and-violence/
The theme of this weekend’s update (diamond jubilee) was “facets of general practice”. General practice is multi-faceted and continues to change, not unlike the subtle changes of a diamond in a different light or in a different position. As practitioners though, we also have many facets and not all of these are visible at first glance. Doctor’s mental health and self care was a recurring theme of the conference and it is clear that we need to look after ourselves and each other. I’m optimistic that our culture is changing (slowly) and as a tribe, I like to think GPs are moving in the right direction. I certainly recharged my battery this weekend (both personally and professionally). I loved reconnecting with my tribe and I was inspired by my colleagues who lead by example. I like to think I keep some pretty good company as #justaGP.