Communication, Culture and Conflict

Dr Celia Gregson

Specialist Registrar in Elderly and Internal Medicine

Frenchay Hospital, Bristol

Pitfalls

Culture

Language

Dress Code

Working Conditions

Hierarchy

Stereotypes

How you see us….

How we see you….

Dress Code

Dress Code

No JeansNo BirkenstocksLeather Shoes, closed toeSmart trousers, skirtShirt / blouseTieWhite coats?Name badge‘Naked from the elbow down’

Language

Video clip Coastguard.mpeg

Communication within the NHS

Patients / families / carers

Nurses

Team members (PRHO, F2, SHO, SpR, Consultant)

The MDT: Physios, OTs, Social workers….

Discharge and referral letters

Breaking bad news

SOH

Communication with Patients

Introduce yourself

Explain management

Ask for consent

Consent forms

Chaperone

Involve in decisions, provide options – AUTONOMY

Non-paternalistic

4 Principles of Good Medical Practice

1. Non-maleficence

2. Beneficence

3. Autonomy

4. Justice

Resuscitation

DNAR

2222

Treatment vs Choice

Autonomy

The Form

How to talk the talk…

To ‘open your bowels’‘Down below’‘Privates’ / ‘private parts’LMP – last menstrual period‘Bloating’To ‘Pass wind’Nauseous and Nausea and NauseatedVomit, to be sick, to ‘throw up’‘Waterworks’Examine the ‘back passage’

‘Doctor I’ve lost a stone!’

1 Stone = 14 Ibs = 6.35kgs

1 Ib (one pound) = 16 ounces = 454g

1 ounce = 28.35g

How tall are you?

‘Five eleven’Five foot and eleven inches5’11

1 foot (ft) = 12 inches = 30.48cm1 inch = 2.54 cm

So….

I’m 5’3 and weigh 9st 5

…..what’s my BMI?

My baby weighs 7lbs 7oz…..

What does this all mean?

Another one…‘How far can you walk on the flat before you get out of breath?’

‘Oh, about 200 yards’

‘Oh about half a mile’

Communication with nurses

Never underestimate the power of a nurse and the impact they can have on your QOL!

Grades A-G

Teams

Sister i/c

Specialist nurses / nurse practitioners

Bed managers

Nurse

Communication with GPs

On the phone Taking referrals Giving advice Discharge planning Seeking information

Via letters Succinct Polite Normal language Copy to patient? –

policy?

CRUCIAL – Interface between primary and secondary care

Working Conditions

Wards

Long Nightingale wards

Curtains

Bays

Notes & stickers

Notes trolleys

Team based vs ward based

Phlebotomists

Ward clerks

The Medical Team

Consultant

Specialist Registrar - SpR

Senior House Officer – SHO

Foundation Year 2 – F2

Pre-registration House Officer – PRHO / Foundation Year 1 – F1

Medical Students

Documentation

Clerking – routine / oncall / proformas

Investigations

Blood results

Ward rounds

Referrals to other colleagues..

Dear Urology SpR

Thank you for seeing this charming 83 year old retired ventrioquist. He has had prostatic symptoms for 8 years, latterly with nocturia x 5. He has an irregular feeling prostate and a PSA of 12. Calcium, ALP and clotting are normal. No bony pain. MSU clear. Dr Bloggs would greatly value your assessment. Thank you.

Dr Under-Bloggs 1749 SHO to Dr Bloggs

Ward round

Meet the team

Consultant lead

Present new cases

List of patients and their whereabouts

Write in the notes

Record necessary investigations

Ward Round NotesDate

Time

S

O

A

P

27/03/06 WR Mr Sharpknife

09.10 am day1 post appendectomy

Lydia well in herself

obs stable, apyrexial

O/E: abdo soft, nontender, BS present

IMP: Recovering well

Plan: Stop ivi, eat and drink, cont Abs total 2/7

 

Little SHO 2273

HandoverWorking the shift system Hospital at Night

Large numbers of patients

Document instructions clearly in the notes

Make plans for the weekend

List all critical patients

Reviews and by whom

Investigations to be checked

Communication with colleagues

ESSENTIAL

Be professional

Be polite

Listen

Do not be afraid to ask

Positive feedback

Keep your sense of humour

Teaching

Grand Rounds

Journal Clubs

Departmental meetings

Xray meetings

Your colleagues – teach and be taught

Do you know….

Time to get competitive…..

NHS & medicine

What is the name of this British GP andwhat is he famous for?

British Sports

Which competition is this and who is this?Other than his sport, what is he infamous for?

British cinema

Name this actor and his role – arguably the most famous figure in British cinema?

NHS & medicine

What is this man infamous for and whatis his name?

British CuisineWhat is the name of these two famous British dishesand which one is always served on Friday in Britishhospitals?

British Television

What is the name of this British comedy

figure and what is she famous for?

British Landmarks

Where is this street located and do any of you

ever think you’ll work here?

Celebrities

What is the name of this famous couple?

What are their nicknames?

Last but not least..Who is this and what’s she responsible for?

Any Questions?