Supervision for superheroes: the case for reflective professional supervision for senior doctors.

The practice of medicine is inherently stressful with regular exposure to trauma and the distress of others. There is a culture in medicine that doctors should not be affected by such things, although it is well recognised that doctors have higher rates of depression, anxiety, suicide, and substance abuse than the general public. Reflective professional supervision is a forum where the complexities of the interpersonal interactions that underpin the provision of healthcare can be explored in a supportive and confidential setting. It is argued that this is a process that should continue for the duration of a doctor's career, with potential benefits including enhanced job satisfaction and resilience, better workplace communication and improved interpersonal skills.

Discontinuity of care at end of life: a qualitative exploration of OOH end of life care.

OBJECTIVE: This study aimed to understand the experiences of palliative care patients when accessing or making decisions about out of hours (OOH) services. It also aimed to illuminate barriers and enablers to accessing appropriate and timely care following the introduction of the 2004 New General Medical Services Contract. METHOD: Longitudinal prospective qualitative study using semi-structured interviews and telephone interviews over 6 months and analysed for thematic content. 32 patients defined as receiving palliative care in six General Practices and three hospices selected on the basis of size and rural/urban location in Southern England were recruited. RESULTS: Continuity of care was highly valued. Participants described the importance of being known by the healthcare team, and the perceived positive implications continuity could have for the quality of care they received and the trust they had in their care. Various factors prevented participants from seeking help or advice from OOH services, despite having health concerns that may have benefitted from medical assistance. Prior poor experience, limited knowledge of services and knowing who to call and, indeed, when to call were all factors that reportedly shaped participants' use of OOH services. CONCLUSIONS: Interpersonal or relationship continuity and management continuity are vital to the process of optimising the patient experience of OOH palliative care. While recent service innovations are tackling some of the issues highlighted, this research reinforces the value patients with palliative care needs places on continuity and the need to improve this aspect of care management.

Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course.

A series of six interprofessional palliative care meetings used narrative, with participants sharing stories from their professional experience in facilitated small groups. The course was attended by doctors, nurses, social workers and emergency care practitioners. The course was evaluated by telephone interview with 19 of the 28 participants. Respondents reported effects including changed behaviours and benefit to patients. The use of narrative, as a starting point for shared learning, discussion and evaluation is unusual. Five months after the end of the course, many participants described changed professional behaviour which they believed led to improved patient outcomes.

Parents' difficulties with decisions about childhood immunisation.

Uptake of childhood immunisation fluctuates in the UK. Convenience, access and parents' relationships with professionals influence uptake. This study explores the decision-making by parents about their children's immunisation through focus groups with analysis to identify categories of concern. Issues raised in focus groups included fear, risk, anger, worry and guilt, confusion, difficulty of decision-making and trust of professionals. The parents of completely and incompletely immunised children shared areas of concern, but there were also significant differences. There was a subset of parents of incompletely immunised children who had decided that their children would not have full immunisation, and this group had little trust in information provided by healthcare professionals. Simply providing more information is unlikely to change their decision.

"You feel so hopeless": a qualitative study of GP management of acute back pain.

BACKGROUND: Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care. AIMS: To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice. METHODS: Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically. RESULTS: There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor-patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor-patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants favoured education that is multidisciplinary, in small group format and involves the participation of patients. CONCLUSIONS: This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.

Acute psychosis following ingestion of 'Rapture'.

OBJECTIVES: To describe a brief psychotic episode associated with ingestion of a dietary supplement containing piperazine. METHODS: A case report was undertaken. RESULTS: A 20-year-old man developed a brief psychotic episode associated with persecutory delusional beliefs and auditory and visual hallucinations, leading him to commit the offence of arson. This episode occurred 12 h following the ingestion of 'Rapture' in addition to small quantities of cannabis and nitrous oxide, in a young man with no prior psychiatric history. This episode resolved with the use of benzodiazepines and 6 months later he has had no recurrence of psychiatric symptoms. CONCLUSIONS: Given the reported mechanism of action of the 'herbal high' dietary supplements, it would seem possible that they may be able to precipitate a psychotic episode in vulnerable individuals. With the increasing use of these substances, it is important for clinicians to be alert to this possibility.