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Author: Antony Willman

  • The Familial Risk of Autism

    On the way to a leaving lunch the other day, I was tuned into Radio 4 listening to an article on Autistic Spectrum Disorder and the lengths to which some parents will go to help their children. One mother interviewed was spending up to £700 every three months on dietary supplements. Her child had been diagnosed with a variety of imbalances and too much mercury (a part of Thimerosal – useful link here: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228). She had also been told children with ASD are unable to excrete certain toxins as well as children without it. To a medical professional who is used to Evidence Based Medicine and with a suspicion of some of the ‘quackery’ practised by certain organisations (plus their fees), I found myself getting angry at people being taken for a ride. I also thought that these parents are so desperate for help and so dedicated to their children, they spend thousands of pounds on treatments which are essentially placebo treatments. An expert in the field made valid comment on the paucity of good quality research out there with only £4M being spent annually compared to £650M on cancer and £150M on cardiovascular diseases.

    Coincidentally I received my daily InfoPOEM today which summarised an article about ASD. I talked about how ICT can be used to help improve knowledge and skills ‘whenever and wherever’. I used to subscribe to this when a) it was very expensive (my subscription of $249 pa expired in 2007) and b) when I was writing my assignment & thinking about how I had used learning technologies in the past to assist in my education. From the Essential Evidence Plus website:

    ‘Daily POEMs (“Patient-Oriented Evidence that Matters”) are synopses of new evidence carefully filtered for relevance to patient care and evaluated for validity. Daily POEMs emerge from continuous review, grading, and critical appraisal of all 3000+ studies published monthly in more than 100 journals. Using Essential Evidence Plus, you will have complete visibility into the archived collection of 3,500+ regularly updated Daily POEMs. Tap into summaries of relevant and essential evidence-based research that are presented in an easy-to-understand format. Quickly identify and understand the information you need and apply the research to your clinical practice’

    It is now $85 pa and I have re-subscribed with one of the intentions of blogging about freely available full text articles raised by InfoPOEMs with my own take on them. One of the concerns I have realised immediately is how easy it is to infringe on copyright and inadvertently plagiarise. I have linked to the InfoPOEMs site in the vain hope lenience will be applied by the judge when I am sentenced as a charlatan poaching other people’s hard work.

    I have linked to the full text of the article. This is essentially a large cohort study of over 2 million patients which looked how relatedness affected risk of ASD. The most closely related were monozygotic twins with decreasing relative risk with reduced relatedness. There is a lot more to it than that though and with such a large cohort, it carries some weight. The article is worth a read as it is relevant to primary care, is a similar population (Swedish) and is applicable in the context of counselling parents who may visit for advice.

    Click to access sandin-et-al_2014.pdf

    https://www.essentialevidenceplus.com/index.cfm

  • Teachers & Social Networking

    British Journal of Educational Technology Vol 43 No 5 2012 754-769

    As part of my assignment on learning technologies, I have done some literature searches. My intent is to critically evaluate a series of articles which look at the impact of Social Media on education. I am not starting in any particular order, just in the order in which I found them. I am trying to evaluate the evidence which looks specifically at Social Media and any effect it has on enhancing knowledge & skills. It would be helpful if you could read what I have written and post any comments. These may be questions about the article, experiences you have had or just some good old fashioned advice.

    The first article I looked at was unfortunately quite long but very relevant. It had a particularly good section on the theoretical background. The article is divided into two. A very comprehensive and well referenced technical background followed by the research itself. For this blog entry (and in attempt to keep things brief), I will summarise the background. The research itself may take me a bit more time to digest & appraise but will be published in due course.

    Firstly, some facts & figures (as of 2011). Facebook (FB) has 900 million users. Two thirds of adults use Social Networking Sites. Facebook is the commonest site visited on higher educational college campuses. Professional Facebooking is a relatively new phenomenon (FB for professional reasons) and has not been explored as much. This study attempted to research the professional uses of FB amongst Italian teachers and evaluate its impact.

    Lifelong learning is a fundamental part of life, not just of compulsory education. It can be described as career related continuous learning as a pattern of formal and informal activities that people sustain over time for the benefit of their career development’ (London & Smither 1999). Ultimately it is about continually updating skills & knowledge. Information & Communication technology (ICT) has driven changes in the workforce to adapt to new technologies. However ICT has also been a driver for change: the concept of learning anytime & anywhere. The authors believe it is not the technology but the way it is implemented and used which it is used which can enhance learning & knowledge. I would agree with this.

    Social networks & social capital have introduced the concept of latent ties (the section of the FB interface which has ‘users you may know’). These latent ties can be converted to weak ties, so called bridging. This is important when we consider Networks of Practice (NOPs). The Concept of ‘communities of practice’ (COPs) was first described by Wenger in 1998. He described 3 parts to them: Domain – identity defined by a shared domain of interest. Community – members engage in joint practices to share information. Practice – Shared repertoire of resources. COPs apply to interdependent practitioners who share & co-ordinate practice. NOPs apply to a collective of all practitioners of a particular practice. COPs are therefore a subset of NOPs (Brown & Duguid 2000). NOPs by their nature are wider groups of like minded individuals. An analogy I recently encountered was at a course where I met other GPs with an interest in education. Before, there was possibly an exchange of phone numbers or an e-mail address. However I would argue how many times have you looked at your contacts some time later & deleted those contact details because nothing has come of it. A NOP is an entity which exists but is enhanced by SNS. This study looked at groups which started as Facebook groups and were actively exchanging ideas, sharing knowledge and engaging in online discussion.

    To finish, I think of one of my GP Trainer work colleagues who is soon to be moving to Scotland. He has got a Twitter account & is engaging in both this & my blog. However as a GP, he has joined the PBSGL we have established in Salisbury Plain. I hope he will continue to make contributions and we will all share best practice via the blog. This, to me, is what a NOP should represent.

  • Mastering Your Risk – MPS course

    The Medical Protection Society run a series of educational courses which are free to members (or a modest fee for non-members).  I have been on three of them now & have found all of them particularly useful.  The most recent one I attended was the Mastering Your Risk.  This was a particularly useful one to go on especially after our last Human Error Problem Case meeting.  I will try & summarise briefly some of my key take home messages.

    It was a workshop based around managing risk before an adverse event occurs (there is also one for after when the adverse event has occurred). This is important as 50% of patients decide to sue before the adverse event actually happens which was news to me. This is for several reasons for example unrealistic expectations and poor communication skills.

    The former was something we may be guilty of in aspects of our practice relating to rehabilitation.  The concept of ‘over promising’ and ‘under delivering’ was discussed.  It is a model which simply doesn’t work in business.  Better to under promise & over deliver.  However as clinicians we do not do this.  I think of the number of referrals to physiotherapy or the amount of time our patients spend under rehabilitation when actually we should be realistic in what can be achieved.  We are not helped by the system penalising patients who are unable to complete all physical tasks. We therefore, as patient advocates, do everything we can to try & restore full function.  In a number of cases this is highly unlikely to be achieved and indeed increases our risk of litigation.

    The latter aspect, communication, we generally do well as GPs.  We use several consultation models usually involving exploring of ideas, concerns & expectations.  The course introduced another model, C.L.E.A.R. ©. This is a 5 part consultation model the mnemonic standing for Connect, Listen, Empathise, Ask, Review (& check).  It reminded me of Roger Neighbours model.  However the important difference was the L.E.A. parts were similar to Pendleton & Tate’s model.  It was a nice combination and whilst discussing & practising it, I thought it might be useful for a Registrar to use.  Neighbour’s model is a useful summary but with an emphasis on safety with Pendleton & Tate’s being thorough yet lengthy.  I have been given permission to discuss this in small groups so I can bring it along to the next PBSGL or Trainer’s Group.

    The workshop was based on some very good research.  The take home article which puts a very poignant perspective on why patients take legal action was by a lady called Susan Sheridan & Martin Hatlie (Sheridan, S. and M. Hatlie (2007). “We’re not your enemy: An appeal from a consumer to re-imagine tort reform.” Patient Saf Qual Healthc 4: 22-26.).  I haven’t read it yet but will have done so by our next PBSGL.  It is an American article but it does have relevant themes.

    Finally the facilitator discussed ‘medical jousting’.  This is the process of criticising other healthcare professionals involved in the care of the same patient.  I think I have probably come across it most with junior hospital doctors criticizing GPs.  I have had several consults where the patient was quoted the F2 ED doctor saying the GP should have given their son/daughter some antibiotics for their ear infection.  It increases the risk of a complaint and subsequent legal action.  I think the take home point is often we do not have all the information to hand so criticism may not be warranted. We also have to ask ourselves ‘would the other doctor concerned want to know what is being said about them by the patient or me?’.  I certainly would & if there is a problem with a clinical decision I have made, I would like to know.  Offer empathy, explain you may not have all the information to hand and certainly offer to contact or liaise with the other healthcare professionals involved.  It can help defuse a situation & lead to a complaint being prevented.

    I have some other interesting nuggets plus an excellent information booklet.  I am happy to share themes and references at the next meeting or discuss anything via this blog in the interim.

  • Top 100 tools for learning

    This list is a pretty comprehensive list of, as the title suggests’ the top 100 tools for learning.  Funnily enough Twitter is number 1 which does not surprise me.  There is an interesting discussion of the pros and cons of social media here with some comments afterwards. Unfortunately the full text cannot be accessed from this site as far as I could see.

    Evernote is something I have been introduced to on learning technology course which is free and cross platform. I would also advocate Google Drive and Dropbox if you haven’t got them.

  • Social Networking and Learning

    This editorial is worth reading if only to whet the appetite for what is happening in SNS (Social Networking Services).  It is from the British Journal of Educational Technology (Vol 43, Issue 5; Sept 2012).  Unfortunately it is not free access. However one of the papers in the journal is available here. In it, Pachler and Cook discuss the relative merits of SNS in both the informal and work based learning environments.

  • Resources

    I have added a new resources page. This will carry permanent links to downloadable teaching and education tools for all to use.

  • June Meeting – Patient Safety

    The June meeting used the Patient Safety – learning from Human Error module.  This was a really useful module as it was less didactic and the members really got into it. The examples from other industries and professions was a good way at analyzing what we do.  The ‘sterile cockpit’ analogy was something we all agreed could be used, for example, simply by shutting down Outlook and re-opening it at lunchtime.  This would allow us to remain undisturbed by e-mails.

    Themes discussed during the session invariably led to how unsafe DMICP is especially when it is not accessible.  There were some positives though.  For example, the hospital referral template letter was shared.  The two week wait Macro enters some text plus the READ code to be used (2WW).  We talked about making a Macro for routine referrals as well.  The use of taskers was also discussed and since the meeting I have adopted this for my own practice.  The tasker menu can be modified in its setup to send admin taskers to oneself.

    One of the module case studies looked at the Kegworth air disaster when the pilot shut down the wrong engine. Despite all the passengers knowing this, no-one did anything about it.  The captain is always right. I prefer the comment of one of my favourite chefs, Nino Ladenis, who said ‘the customer is not always right’  (this related to a customer requesting tomato ketchup for his Michelin three starred meal).  We went on from this to talk about an anonymous safety reporting system but agreed if the SEA/PSIR system is working well and you foster a climate of open reporting and no blame, this is not necessary.

    Several resources were discussed.  Jennie has since circulated her task sheet and the book ‘Do It Tomorrow’ was mentioned.  The use of taskers for electronic referrals at Bulford is impossible due to the number the Practice Administrator gets (5 to 20 notifications a day for confidentiality breaches).

    It will be interesting to see how everyone gets on with looking at access to them and how they can manage that. It would be useful if members can look at their own practice and reflect on it.  When was the last PSIR you had down to human error?  How can you mitigate when DMICP goes down?

  • Welcome

    Welcome to the first blog entry of our PBSGL Blog!  I would appreciate it if you can spend a bit of time reading through this as a an invite to participate.

    This blog has two purposes.  I unashamedly am using you as my Guinea Pigs for my assignment whilst participating in the Learning Technologies in Healthcare Education module of my MMedEd.  The purpose in this context is to assess the educational impact of the blog in enhancing learning following our face to face discussions.  Secondly I thought it might act as a tool to follow up on our sessions, sharing best practice, discussion of the cases and unanswered questions.  I am hoping by participating in this blog, your learning will be enhanced.

    The blog will work as a discussion following the small group work.  I will summarise what was discussed.  I will then post it and link to it via my micro blog (Twitter).  What I need you to do is to obtain a Twitter account (free) on whichever platform you want.  If you could then follow me (@sppbsgl or @upavondoc), you will receive updates when they are complete.  Alternatively you can visit the blog directly at http://salisburyplainpbsgl.wordpress.com.

    I hope everyone will participate.  It may be a blog is not the best way to do the post meeting discussion but it seems the easiest way to start.  Be aware the blog is open to the public so be careful when posting comments about patients.  Use general principles not specifics.  By all means link to websites and other resources.  I hope we can all share our combined knowledge this way.

    Each blog entry will be in the format <month> meeting – <subject>.  I hope to tag the keywords to allow searching easier at a later date.  Once I hope it is established, the plan would be to open up the blog to other administrators to initiate posts.

    As e-moderator, I will ensure that comments respect patient confidentiality as well as the copyright of the modules.  I don’t expect this to be particularly onerous as we all have a modicum of common sense.

    At a later date, probably after two more modules, I will ask your for your feedback. In particular if the on-line discussion has enhanced your learning.

    I will e-mail this out via the usual distribution list but if you could spend 2 minutes either registering for a Twitter account & following me or just following me, I would be grateful.  Thanks.

  • Test

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