Omar, a 4th year medical student, is invited to an end of placement meeting at Wild Meadow Practice where he has spent the past month building his understanding of general practice.
Omar reflects with his supervisor, how valuable he has found the GP catch up sessions each lunch time, where they would briefly meet to discuss complex cases and share decisions about how to best support their patients. Other practices where he’d trained hadn’t built this opportunity for discussion into their working day.
He found it insightful to see how many decisions were complex and required the use of wisdom to help articulate gut feelings, where guidelines were lacking - he hadn’t realised how intellectually challenging general practice could be.
The discussions reminded him of hospital multidisciplinary team meetings where investigation results would be discussed between teams to reach a collective decision. Omar's supervisor encourages him to consider the differences between discussions he has observed in hospital and general practice...
The following day, Omar’s supervisor shares this feedback with the wider team at their catch-up session. All the GPs agree how valuable the sessions have been to help them share uncertainty, build on their professional wisdom and explore, explain and evaluate their gut feelings. One of Omar’s colleagues shares a resource they have discovered - WiseGP - where they have read about this knowledge work process (the complex decision making of everyday practice) and how they could develop their skills further.
Omar makes a note to explore the WiseGP website to find out more!
The team reflect on recent political pressures to increase appointment capacity despite the invisible work they face each day, evaluating and responding to gut feelings. Together, the GPs decide to try and make this work visible; by adding an appointment list, where GPs can book patients in for discussion at each lunchtime meeting - a ‘discussion with colleagues’ note is added where relevant. They plan to use these appointments as evidence for how long GPs spend on this ‘invisible work’ and to demonstrate the time and headspace required to make these complex decisions.
Recognising the importance of continuity of approach across a whole general practice team, the GPs ensure all team members can join the catch-up meetings, with the nurse practitioners and physician associates finding it particularly valuable to attend and participate in the discussions.
The team also decide to trial a longer multidisciplinary team meeting once a month, where chronically ill patients with complex problems can be discussed in the presence of representatives from wider PCN team members including the social prescribers, occupational therapists, physiotherapists and pharmacists to facilitate a co-ordinated whole-person centred knowledge work approach to care at the practice.
Are you doing this invisible ‘knowledge work’, understanding, critiquing and applying your gut instincts?
Do you make this work visible to students, so they can appreciate the intellectual challenge of our profession? Read our GEM on this topic.
Do you have an opportunity to share and critique your gut feelings with colleagues and do you record these discussions?