reflect Flashcards
Gibbs reflective cycle
Description:
What happened in the situation? (Brief overview)
Feelings:
How did you feel during the experience?
Evaluation:
What was good and bad about the experience?
Analysis:
What sense can you make of the situation? (Why did it happen?)
Conclusion:
What did you learn from the experience?
Action Plan:
What will you do differently next time?
describe event
While working on a psychiatric geriatric ward, I reviewed an 80-year-old woman admitted for a recurrence of bipolar disorder after 40 years of stability. As resident doctors we looked after patients both physically and mentally. On further history and examination, I noted symptoms of fatigue, unintentional weight loss, increased thirst, frequent urination, and constipation. Her blood results showed raised calcium and PTH, and examination revealed an enlarged parathyroid gland. Ultrasound confirmed a parathyroid adenoma. After consulting with ENT and endocrinology, she was transferred to the hospital, where she was diagnosed with primary hyperparathyroidism and planned for parathyroidectomy. Her psychiatric symptoms were likely triggered by hypercalcemia.
feelings around event
I initially felt upset that her physical symptoms were overlooked, likely due to her psychiatric presentation. However, I felt proud of identifying her condition as a newly qualified doctor and grateful for the collaborative efforts that led to her appropriate care.
evaluate event
The positive aspects of this case included effective history-taking, critical review of admission bloods, and prompt communication with ENT specialists. However, it highlighted a concerning gap where her physical symptoms were overshadowed by her mental health condition.
analysis of event
This case emphasised the importance of holistic care, especially in patients with dual diagnoses. The incident aligns with the Swiss Cheese Model, where multiple system failures (e.g., lack of initial blood tests, physical assessment) could lead to harm. Clear documentation, regular review of results, and vigilant symptom assessment were key factors in preventing a missed diagnosis.
conclusion
I learned the value of treating patients holistically and ensuring physical symptoms are not overshadowed by psychiatric diagnoses. This case reinforced the need for duty of candour, escalation to seniors, and shared learning among teams to improve future outcomes.
action plan
I now prioritise treating patients more holistically by considering both their physical and mental health needs in every assessment. I ensure thorough documentation, regular review of results, and timely escalation to seniors when concerns arise. Additionally, I actively share learning from such cases with colleagues through debriefs, team meetings, and reporting systems like Datix to prevent similar oversights in the future. By fostering shared learning and a holistic approach to care, I aim to improve patient safety and outcomes.
How do you use similar reflective practice in your daily work?
Day-to-day, I engage in informal self-reflection, evaluating my actions and those of others to continually improve my practice. Completing the Edward Jenner Leadership courses (levels 0 and 1) greatly enhanced my self-awareness and underscored the importance of regular reflection. Daily reflection on my way home helps me to set my boundary for work/home. I use Gibbs’ reflection model for formal reflection on significant events, helping me analyse and learn from experiences systematically as done in prev answer. As a paediatrician, this skill is vital, as being insightful about oneself and ongoing situations is key to effective communication and ensuring the best outcomes for children and their families.
- Please could you briefly describe a significant clinical event you were involved in or observed and discuss your learning from it?
My significant clinical event was during F1 While working on a psychiatric geriatric ward. I reviewed an 80-year-old woman admitted for a recurrence of bipolar disorder after 40 years of stability. As resident doctors we looked after patients both physically and mentally. I assessed patient by thorough examination and history and I also took admission bloods. On further history and examination, I noted symptoms of fatigue, unintentional weight loss, increased thirst, frequent urination, and constipation. Her blood results showed raised calcium and PTH, and examination revealed an enlarged parathyroid gland. escalated to seniors. After consulting with ENT and endocrinology, she was transferred to the hospital, ultrasound confirmed a parathyroid adenoma and she was diagnosed with primary hyperparathyroidism and planned for parathyroidectomy. Her psychiatric symptoms were likely triggered by hypercalcemia.
I was initially upset that her physical symptoms were overlooked, likely due to her psychiatric presentation. I was also disappointed that she had not been given the same standard of care as someone without a previous diagnosis of bipolar may have received. It is important to keep an open mind and not to rely on previous diagnosis. However, I felt proud of identifying her underlying condition as a newly qualified doctor.
The positive aspects of this case included effective history-taking, review of admission bloods, thorough examination and prompt communication with local specialists. However, it highlighted a concerning gap where her physical symptoms were overshadowed by her mental health history and presentation.
This case emphasised the importance of holistic care. I think of the swiss cheese model and how due to multiple failures (e.g., lack of initial blood tests, physical assessment) could have led to harm and a missed diagnosis.
I learned the value of treating patients holistically and ensuring physical symptoms are not overshadowed by psychiatric diagnoses. This case reinforced the need for duty of candour, escalation to seniors and specialties, advocating for patients and shared learning among teams via Balint groups or other means to improve future outcomes.
I now prioritise treating patients more holistically by considering both their physical and mental health needs in every assessment. I ensure thorough documentation and timely escalation to seniors when concerns arise. Additionally, since this case I actively share learning to prevent similar oversights in the future. By fostering shared learning and a holistic approach to care, I aim to improve patient safety and outcomes.
