merriman honor

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The variety of problems we meet every day as GPs is one of the pleasures of the job; each patient presents a different type of challenge. Understanding what is really worrying the patient is most of the task but another part is having enough current medical knowledge to inform a management plan. What is the remedy? How do I know what needs to be looked up? Do we all need to be more curious about best practice?

One of the most surprising things about being a GP appraiser is that so many GPs say that accumulating evidence of learning seems to be a burden of ‘getting enough CPD credits’. Surely each day at work presents stimulus to learning? It does for me anyway, perhaps I know less than other GPs! Making a note as a PUN/DEN or case report provides CPD credits and this learning feeds into improved care for my patients. Learning from day-to-day experience is only part of the solution. The real problem for me is the changes in clinical practice that I know nothing about, the unknown unknowns, the things I do not look up because I don’t know that I don’t know them.

I am fortunate that I work in a practice where we talk to each other every day and have regular in-house education meetings. This is a good way to question my practice. The local CCG used to encourage us to meet in the practice to review our referrals. I suspect that the real motive here was to save money by not referring patients to secondary care, but the meetings were a good way to compare our clinical management with each other, and with secondary care outcomes. This may have encouraged us to offer more procedures in house, and we also learnt of treatments that we could not provide ourselves but would still be of benefit to patients. Overall, no money was saved.

I am also lucky to have good sources of information at work. The GP page on the CCG website and DXS on our practice PCs both provide useful guidance. I also use the BNF daily. The Guidelines app is installed on my iPhone so I can look up national guidelines on a wide variety of clinical topics. My memberships of the BMA and RCGP provide online resources as well as journals to broaden my view on what other doctors are thinking and writing about.

What else can alert me to check out information? National conferences (for example the RCGP annual conference) and one-day learning events. In areas where protected learning time is provided (not locally for me, sadly) there is the opportunity for core skills to be updated and time allowed for team development. Incidental learning from conversations with other local practices must be invaluable.

So after these thoughts, what have I concluded to avoid unknown unknowns? Always be curious and assume nothing.