An ECT visit with a twist

The GP registrar, Dr S, took a big breath before bringing in her first patient from the waiting room. It was her first ECT (External Clinical Teacher) visit and she was probably wishing she’d been booked in for the other kind of ECT instead.

“I’ve got another doctor sitting in with me today as part of my training. Is that okay, Jacquie?”

“Sure, no problem. I’m just here for my results and a quick script,” replied the 50-something Jacquie as she walked with Dr S down the corridor.

In contrast to Dr S’ obvious discomfort, Jacquie seemed perfectly at ease — until she saw me sitting in the corner. Her eyes widened and then carefully avoided any further contact with mine. She twisted and untwisted the strap of her handbag.

“Are you okay?” Dr S asked. “You seem kind of jumpy.”

The response came through gritted teeth: “I’m fine.”

“Good news about your results. They are all normal. I’ll go through each one with you now. The arsenic level was undetectable”

“No need to go through them. Can I just get a printout please? I’m in a bit of a hurry.”

“Well, okay. You wanted a copy for your naturopath, didn’t you?”

“Umm, no. Just for me.”

Dr S looked confused.

“But didn’t your naturopath give you the list of the blood tests she wanted you to have done?”

“Umm, oh, that’s right. I forgot.”

Dr S shook her head almost imperceptibly as she printed out the results. She turned back to Jacquie.

“And your script?”

“What script?”

“You mentioned you wanted a script. Was that for temazepam?”

“No, I don’t need a script. I have a spare one at home. I forgot.”

Dr S was struck with the possibility of an interesting diagnosis. Her face lit up momentarily before settling into a caring but concerned expression.

“You seem to be having some memory problems, Jacquie. I’d like to ask you a few more questions if that’s okay?”

“Not today, I’ve got to go. Thanks.”

Jacquie flew out of the room, clutching her pathology results.

Dr S turned to me, her brow creased with concern.

“Well, I stuffed that up. Should I have handled the memory issue differently? She seemed really scatty today — she’s never been like that before. Do you think early onset dementia is a possibility?”

“Just take a deep breath. You didn’t do anything wrong. Sometimes there are other things going on.”

I smiled and explained that Jacquie was a regular patient of my practice, 50km away. She’d been in to see me only a week earlier when she’d asked for a range of unusual blood tests as requested by her naturopath. I had not ordered them. I had, however, given her a script for temazepam, which she insisted she used only occasionally.

As is the case with most registrars, Dr S soon relaxed into the ECT visit and found the experience valuable educationally.

It was valuable for me too. And for Jacquie. Somewhat to my surprise, she came back to see me, contrite, and we had a frank and open discussion about what had happened.

Her memory is just fine, although she wishes she could forget that embarrassing day.

(Names have been changed and permission has been obtained from the involved parties for this account to be published).

First published in Australian Doctor on 9th August, 2012 On an ECT visit about an encounter I had a few years back, but memorable even now…

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-an-ect-visit

I love being mistaken for a medical student

“Are you learning a lot today, dear? Are you going to be a GP too one day?”

My face breaks into a smile for a number of reasons. I love it when, as a medical educator, I’m mistaken for a student while conducting external clinical teacher (ECT) visits.

First, if patients mix up which one of us is the registrar and which is the teacher, it usually indicates they trust and respect the doctor they’re consulting.

Second, it can help put a nervous registrar at ease. We have a chat and a laugh about it afterwards, and I can almost see their confidence level rising.

And third, it makes me feel young.

Before you try to burst my bubble, I know med students are not all bright-eyed 20-year-olds, but I still take it as a compliment.

For the uninitiated, ECT visits are compulsory components of GP training nationwide. Each involves a medical educator visiting a registrar’s practice and sitting in for a session, after which a report is written and kept on file.

There are some registrars who relish the idea of an educator observing and commenting on their clinical performances in a career they’ve only recently started.

They’re usually the same type of people who like doing karaoke without the benefit of inebriation, think nothing of standing up in front of a crowd to deliver impromptu speeches, and apply for reality TV shows.

Most, however, are at least a fraction anxious about their first ECT visit. For starters, having the name ‘ECT’ doesn’t exactly engender comfort and reassurance. Those who chose this initialism might have thought it amusing, but I haven’t seen many registrars laugh about it.

Indeed, one even told me she’d had a nightmare in which she received an electric shock every time she asked too many closed questions or didn’t pick up on non-verbal cues.

The training provider for whom I work has changed the name to ‘FACT’ (Formative Assessment Clinical Teaching). However, the FACT of the matter, as I see it, is that an ECT visit by any other name still smells of fear.

Most registrars relax into ECT visits pretty quickly and find the experiences educationally valuable. By the end of that first nerve-wracking visit, many say things like, “That was great — I wish you could come every week.” A few actually mean it!

I used to be nervous conducting ECT visits too. Back in 2005, when first starting out as a medical educator, I worried that I was too young and inexperienced. What if a registrar asked me a question I couldn’t answer? It took me a while to realise I didn’t need to know everything to be a good teacher, and that getting the registrar to look something up was not only okay, but a valid educational strategy.

In those early days, patients often mistook me for a student, but I didn’t view it as complimentary. I was still young enough to want to look older.

It was a bit like being asked for ID at a club. At 20, many people are miffed to be asked for ID: “There’s no way I look underage!” At 25, they think it’s mildly amusing: “I look underage? That’s pretty funny!” However, by 30, they are desperately hoping that someone, anyone, would mistake them for possibly being a teenager.

I’m now very comfortable being the age I am and have no desire to be a teen again. Nonetheless, the occasional medical student misidentification is not unappreciated!

 

First published in Australian Doctor on 13th July, 2012 On being a medical educator

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-being-a-medical-educator