PROFESSIONALISM IN FAMILY PRACTICE
EXAMINATION NUMBER: B144502
CHOICE OF TWO REFLECTIVE CONTRIBUTIONS
A)FIVE STAR ROLE OF A FAMILY PHYSICIAN
From the available history, I can deduce the following problems/needs that mama Lambola has that I must address
1) BIOMEDICAL PROBLEMS: Severe low back pains. Lifestyle issues concerning her occupation as a farmer at her age as well as a possible malignancy.
2) PSYCHOLOGICAL PROBLEMS: Worries arising from: Loss of function as a matriarch, as a farmer, as a grandmother and as a person.
Worry over failed traditional medication.
3) SOCIAL PROBLEMS: a matriarch, with huge responsibilities towards her family and now grandchildren, family elders having to take a major decision for her, last daughter’s education truncated (rebelliously), failed traditional medicine which a typical African community relies on so much as well as investment in time, travel and money to come to the hospital.
In addressing her problems, I chose the MANAGERIAL ROLE for the fact that her care requires a multidisciplinary approach which I as a Family Physician will co-ordinate as a good team player.
And other five star roles dovetailing into this as I manage her will include:
CAREGIVER- As a first contact doctor, I will clerk and examine her with a patient centred approach, then do investigations cost effectively. Then based on my findings, I may admit her since the pain is severe or refer her to a specialist of course, with her duly informed consent. From this, the manager role plays out as I manage her acute condition as a person, manage her resources and manage my colleagues as I admit or refer her.
COMMUNICATOR: As a communicator, I will address lifestyle issues with her and the family as well as identified risk factors, she will also be made to understand my findings and line of management as well as expectations. Most importantly, I will like to have a family conference with her and family members including the last daughter in order to resolve the issue of her truncated academics. We may resolve to get a relative, who with the grandchildren can assist Lambola with house chores, farming and other domestic needs. The African close family tiers will be a good resource here. With this also I would apply my managerial role of managing the family members as team players in this case.
COMMUNITY LEADER: From madam Lambola’s case, I would be able to identify the health risk of her community and make efforts to address them as the case may be. Every member will be made to understand the importance of lifestyle modification as stakeholders/partners in the overall health of the community. So here the managerial role will be brought to fore.
DECISION MAKER: As a decision maker, I will apply the best and yet most cost-effective regimen in managing Lambola, either in terms of investigations or in terms of treatments
Before I go into the discussion, I would like to say something about the distinction between MENTORING AND ROLE MODELLING—‘Mentoring includes role modelling: mentors are usually senior colleagues influencing the younger in their career. While role modelling involves teaching by examples to influence professional identity in various ways. It is less intentional, often unaware, more informal and more episodic than mentoring. (Nuala.P et al 2003)
So in being a role model to this nurse during this encounter with mama, we would have taken time to reflect over what went wrong in his last encounter with mama beforehand in a non-judgemental and encouraging manner. This is because reflection is a way of learning. Then when mama comes in, and permission has been given by her for the nurse to be present during her consultation, we will both apologise to her for what went wrong before.
By this, I am teaching him humility and restoration of patient-caregiver relationship that is very vital in managing this complex case with all the psychosocial issues.
I would go ahead to counsel mama about her condition and the way forward taking care to divulge any other sinister finding from her examination and investigation.-This will show the nurse a better way to handle clinical information and communication skills especially in breaking bad news which he did not do well in mama’s last visit-
He will learn by observing how I go about the encounter
Subsequently, I would keep interacting with him by way of follow up and request that he joins me in seeing other patients to learn more.
Nuala P. Kenny, OC, MD, Karen V. Mann, PhD, and Heather MacLeod, MA. Role Modeling in Physicians Professional Formation: Reconsidering an Essential but Untapped Educational Strategy.Academic Medicine, v o l . 78,12 ; 2003
JUSTIFICATION FOR THE CHOICE OF THESE TWO CONTRIBUTIONS
I chose to present my five-star role and role modelling contributions in this reflective exercise assignment because I feel the need to reflect more on the unique profile of the Family doctor as a five-star doctor and the process of role modelling to imbibe these attributes as a way of achieving the desired long lasting change. The importance of Family Doctors in healthcare reform in every country across the globe cannot be over emphasized as stated by Dr Charles Boelen in his paper (1994).
These two contributions were my best contributions in this course.
As I reflected on the different five roles of the family doctor, I realised that this mix of attributes is something I must constantly remind myself of in my practise. I need to regularly consider the care of the patients community. It is easier for me to perform in my skills as a care-giver, a communicator, and a decision maker in the hospital but not so conscious of my skill as a community leader. I considered community health issues the problem of Community and Public Health Physicians.
Role modelling and mentorship are two closely related concepts that are recently being emphasized in the postgraduate medical colleges of my country. It is an educational strategy with proven importance in influencing learners behaviour, professional attitudes and career choice (Francine Lemire 2018).
Reading the resources on Role Modelling was an eye-opener for me.
ANALYSIS AND EXPLANATIONS OF THE CONTENT OF THE REFLECTIONS(GIBBSCYCLE MODEL)
These contributions were in response to a case study on Mama Lambola, a 57-year-old matriarch of a homestead in a big African hinterland who was a farmer (kept goats and grew vegetables), saddled with the responsibility of her grandchildren that have been sent by her children in the city to be raised in the traditional way. The upkeep of the home however, was taken care of by the money sent by her children in the city.
DESCRIPTION: Mama Lambola developed a severe low back pain that has affected her functions as a farmer and home keeper. Traditional treatment has failed her and now she has spent a lot of money, travel and time to visit the primary care clinic where I work for help. The family elders recalled mamas daughter from school in the city to help her mother against the girls wish. From my assessment, she was thin with undiagnosed hypertension, dyspnoeic on moderate exertion (but blamed it on her inability do farm work), with a kyphoscoliosis and spinal tenderness.
Along the line, mama and daughter were dissatisfied with the way the nurse communicated the hypertension diagnosis and her risk of developing stroke to her which didnt go down well with them. When my attention was called to this ugly development and I quickly reassessed her. By her next appointment, a week later, I had to get her permission to allow the same nurse consult with me (she had earlier indicated she wanted to see me only) while seeing her to help me take notes and with other clinic activities as well as role modelling him in communication skills.
FEELINGS: I felt confused and inadequately prepared to handle the situation. I felt a bit angry with the nurse also. I had other patients waiting and this was an additional work for me and might take so much of my time to resolve.
EVALUATION: It was good that they showed their displeasure before leaving the facility otherwise that would have spelt doom for us if they had taken it to the community before we resolved it. It was also good that she returned to the clinic for the next appointment and even permitted the nurse to be present during the consultation for us to fix the problem together and probably restore the relationship between my team and mama. Mama being angry and dissatisfied with us was bad.
The poor accessibility of health facility and cost, affect patients health seeking behaviour. These are often responsible for alternative care and late presentation to health facilities (Onyemaechi et al 201). Mama had to invest so much time, money and travel to attend the clinic after a failed alternative treatment. All these, coupled with her biomedical and psychosocial problems might have contributed to her anger and irritation, hence her reaction to the nurses information. Mama may have judged the way the nurse communicated her diagnosis and prognosis disrespectful. She probably expected me the team leader and not a junior in the team to do it. Also, it could be that she expected to be attended to expressly being a leader but had to wait for her turn before seeing the doctor. Waiting time and poor communication as we saw in this case are known causes of patients dissatisfaction in clinics (Lee. V.A et all 2010). Overall, I can see that she was not accorded the regard she deserved by her position in her community.
CONCLUSION: My team should have been more sensitive to her social and psychological needs and not just her biomedical needs alone. The communication about diagnosis and prognosis of hypertension should have been done by me as the head of the team and one with better communication skill.
ACTION PLAN: If this arose again, we would do better as we would have made some changes in terms of professional improvement and growth of team members from continuous professional development and reflection especially the nurse.
DISCUSSION OF THE DEVELOPMENTAL ROLE OF REFLECTION
INTRODUCTION Many definitions of reflection abound but generally, reflection means throwing back of thoughts and memories in cognitive acts such as thinking, contemplation, meditation and any other form of attentive consideration, to make sense of them, and to make contextually appropriate changes (Taylor 2010). The process of reflection and reflective competency are powerful for maximising deep and lifelong learning, and for achieving higher levels of responsive professional practice in a medical career ( Hargreaves 2016). The importance of reflection in lifelong medical learning and medical professional development which transcend to better patient outcome has been proven (Hargreaves 2016).
Prior to this course, I reflected unconsciously especially in event of an unexpected outcome, more like a review to unravel what went wrong, unaware of its educational/professional value.
APPLICATION OF LESSONS LEARNT
My experience so far in this course, with the progress I am making in my reflective learning and practice, I can say that I am gradually becoming a reflective Practitioner which will translate to better patient outcome.
I am getting better in critical thinking and evaluation of cases and learning from my past experiences. For example, reflecting on Mama Lambolas case has taught me to be a better team player/leader, and the value of social workers roles in the healthcare team.
I am developing a deeper sense of self-awareness and this is helping me appreciate areas of professional strengths and deficiencies that must be addressed (Jorwekar GJ 2017). For example, until I reflected on the five-star skills of Family Physicians, I did not see my deficiency in the community leader skill.
I am gradually improving in personal and clinical confidence as well as in self-motivation and self-directed learning (Jorwekar GJ 2017). I am learning to make clinical decisions with certainty especially in complex cases like Mama Lambolas case and, learning from past experiences.
Reflective learning and practice is a good source of feedback for me after a clinical encounter like a self-appraisal so that I can make the necessary adjustments (Jorwekar GJ 2017). By this, I am learning more from experiences or situations and acquiring new knowledge and skills.
Reflection has enabled me avert a major prescription error in my practice. I had made a major error in my prescription for a patient due to work pressure. Later that day, as I reflected on her case and the encounter, I realised the error and immediately put a call through to her to correct the prescription. This saved her life and my career.
As good as these may sound, I feel it is time consuming and so discouraging (Jorwekar GJ 2017) trying to reflect on past experiences with a tight work schedule. I struggle often with this except for my strong self-motivation.
It may appear like a self-criticism, a journey some people may not want to undertake because of the emotional effect especially with issues you quickly want to forget (Jorwekar GJ 2017).
There is also that confusion about which situation to reflect on and it may not be adequate to resolve clinical skills (Jorwekar GJ 2017).
CONCLUSION: Reflection is a unique, powerful, inexpensive but tacit learning tool with proven benefits to identity growth and professional development that can improve patient outcome on the long run.
Kenny N, Mann KV, MacLeod H (2003). Role Modelling in Physicians Professional Formation: Reconsidering an Essential but Untapped Educational Strategy. Academic Medicine, 78, (12) 2003
Boelen, C (1994). The Five-Star Doctor; an asset to health care reform? World Health Organization, Geneva, Switzerland.
Benbassat J, (2014). Role Modelling in Medical Education: The Importance of a Reflective Imitation. Acad.Med.2014,89(4); 550-554
Lemire F (2018). Role Modelling in Family Medicine Education. Canadian Fam Phy. 2018, 64.
Onyemaechi N, Lasebikan OA, Elachi IC, Popoola SO, Oluwadiya K (2015). Patronage of Traditional Bonesetters in Makurdi, North-Central Nigeria.Patient Preference and Adherence. Available at ( Accessed 13-Jun-2019).
Lee V A, Moriarty JP, Borgstrom C, and Horwitz L.2010. What can we learn from patient dissatisfaction? Analysis of dissatisfying events at an academic medical center. J Hosp Med. 2010 ; 5(9): 514520.
Taylor J 2010. Re?ective Practice for Healthcare Professionals: A Practical Guide Third edition. Open University Press 2010.
Hargreaves K 2016. Reflection in Medical Education .Journal of University Teaching and Learning Practice. 2016; 13(2): 6.
Jorwekar GJ 2017. Reflective practice as a method of learning in medical education: history and review of literature. International Journal of Research in Medical Sciences 2017 5(4): pp 1188-1192