GP New trainers course – Case History 2.

Added on - 30 Sep 2019

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GP New trainers course – Case History 2Case study 2Reflecting and giving constructive feedback - Most important attributes in teaching and training.IntroductionOne day a nurse requested me whether I could authorize a prescription for a patient he had seen with amild temperature and an abdominal pain whom he thought was having a UTI. Instead of authorizing theprescription, I felt that I should examine this patient. On examination I found out that he has a very tenderabdomen with some guarding. His urine had trace of leucocytes and blood, but otherwise normal. Patientneeded immediate admission to the hospital for further assessment.In this situation I decided to assess the patient rather than prescribing as requested by the nurse. Itprompted me to examine the patient due to lack of information provided by the nurse to be confident thathe had a UTI. This particular nurse was new to the practice and I was not quite aware of his competencelevels either.I found it hard to disagree with this senior nurse, (even though he is new to our practice) and instead ofprescribing, straight away deciding to go and assess the patient. I felt difficult in disagreeing with hisdiagnosis but after explaining the reasons he agreed. I felt it even harder as he had a trainee nurse withhim as well shadowing his consultations. Apparently his trainee has checked this patient’s urine sampleand had told him that it is abnormal rather than he himself, double checking what was the realabnormality. It served to be a good learning lesson for the trainee as well as he had no knowledge abouturine dip stick abnormalities. I examined the patient with the nurses and explained to them why it can’t bea UTI. I did give them the opportunity to examine the patient. Also they were present when I took adetailed history. Once I have dealt with the patient I wanted to reflect on this situation and to think aboutthe best way I could use this situation to educate the nurses. I wanted to be as constructive as possible.I gathered information.Then I decided to discuss the situation briefly with the nurse involved. We then decided it would be agood learning opportunity. I have learnt from my trainer’s conferences and workshops about SignificantEvent Analysis (SEA). SEAs are a good source of learning if everyone take it as a learning experience.So I wanted to make this a learning experience to the nurse and the trainee nurse as well. So weprepared for the SEA meeting. Advised the nurse to write the incident and to look at what he would havedone differently.I also advised to read about diagnosing a UTI and differential diagnosis of abdominal pain. Also wediscussed about best way of seeking advice if he was unsure about the diagnosis. Better to ask for anassessment rather than asking for a prescription. If I did fail to assess the patient and had given theprescription, I would have certainly put the patient at risk.
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