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ICGP Winter Meeting

Mentoring could help GPs cope with adverse events

Culture change and mentoring from experienced GPs would help younger doctors overcome adverse events, a session at the ICGP Winter Meeting heard.

Dr Andrée Rochfort, ICGP Director of Doctors’ Health, and Drs Deirdre Kinlen, Monica McWeeney and David Thomas of the Retired GPs Discussion Group, presented a talk on coping with adverse events in practice.

All GPs had either experienced or witnessed an adverse event, noted Dr Rochfort.

Dr McWeeney agreed that “virtually every practitioner knows the sickening realisation of making a mistake. You feel singled-out and exposed”.

The adverse event, she said, was agonised over and replayed in one’s mind. Many factors could contribute to an adverse event, including over-work, lack of resources, isolation, burnout or substance abuse.

“Failures of communication is the really big one,” continued Dr McWeeney, “and that can be between consultants, other healthcare professionals and actually within your own practice.”

When an adverse event does happen, it is important to recognise it and not be defensive or in denial.

“We need to talk and we need to learn from other professions to change our culture,” she said.

Dr Thomas said understanding the underlying cause of an adverse event was key and that other sectors, such as the airline industry, had much to teach the medical profession.

“We need open disclosure, be it one-to-one, at practice meetings, or even in the more formal setting.”

Dr Kinlen said that doctors can be affected by adverse events years after they occurred.

Speaking to The Medical Independent after the meeting, Dr Kinlen explained that doctors had responded well to the talk, which had originated from a workshop she gave about caring for doctors and listening support.

“At that first workshop, we discovered that although most people could list off a few areas of support, including colleagues, there were a number of GPs, particularly towards the end of the meeting, who admitted that they had not been happy with the support they had received and would have loved more support.”

She added: “What is really coming across very strongly is that doctors are starting to admit that they really need some kind of supportive mentoring and supportive listening.”

Dr McWeeney said the Retired GPs Discussion Group is hoping to establish a mentoring system.

“How we’re going to do it… we’re still in negotiations. We also are going to roll-out what we did today through the Faculties,” she commented. 

Communications is key in battle for resources, hears ICGP meeting

The need to better communicate the importance of general practice to the public was emphasised at the recent ICGP Winter Meeting. 

Members wanted the College to do a better job in advocating, lobbying and engaging in public relations, Communications Chair Dr Mark Murphy told fellow GPs. Speaking at the keynote discussion ‘Evolution of General Practice — How the College Will Play its Part’, Dr Murphy said general practice was in “absolute crisis”, having been “crippled” by FEMPI cuts.

He promised that the ICGP would campaign for adequate resources and not “look to false gods and adapt to places we shouldn’t go to.

“I’m talking about private hospitals bypassing general practice. They are marketing to vulnerable people on the radio to bypass their GP to go straight to that institution,” he said to a round of applause.

“I am talking about a whole industry of over-diagnosis and over-treatment. I am talking about corporate pharmacies, not our wonderful community pharmacist who is an integral member of the primary care team.

“I am talking about for-profit chronic disease management and the bypassing of evidence-based medicine.”

He described GPs as the stalwarts of evidence-based, person-centred care and while there were challenges, “the College will never endorse something that is not resourced”.

“There will be changes but we will always represent your voice.”

However, the College would need to adapt to a “new political world of populism and celebrity”, said Dr Murphy, who asked GPs for their ideas on how the ICGP can better communicate with the public.

Speaking from the floor, Waterford GP Mark Rowe emphasised the importance of disseminating the College’s message.

“We have to make our dream the dream of the four-and-a-half million people in this country. They know good service when they get it but that’s not what they’re hearing in the media. They’re only hearing the bad stuff.”

Dr Murphy said he had attended the recent RCGP annual conference, where he met the College’s head of PR. He praised the UK college for its lobbying efforts and “fantastic media drive”.

“It was not the BMA that won over the Tory government to increase funding for GPs from 7 per cent to 11 per cent, it was the RCGP,” he said.

“We are not negotiators but we absolutely can argue for improved resources and I will always do that.”

Dr Brendan O’Shea, Director of the Postgraduate Resource Centre, ICGP, said a more visible presence in the national media would be helpful.

GPs discuss malaria risk posed by immigration  

Almost all malaria cases reported in Ireland involve people who were visiting friends and relatives (VFRs) in countries where the disease is endemic, GPs were told at the ICGP Winter Meeting.

People from malaria-endemic countries may have had innate immunity but this recedes when they emigrate to countries like Ireland, Dr Conor Maguire, President of the Travel Medicine Society of Ireland, informed the meeting.

While it can be challenging to advise VFRs and others on the dangers of travelling, he added that travel medicine is about empowering patients to make the healthy choice.

“It’s about empowering the patient, advising them on self-management and self-treatment, and explaining to people where the risks are.”

Women are much more prone to the side-effects of antimalarial drugs, he explained, and not travelling is always an option.

He warned that drowning is the second-biggest cause of death for young people while travelling, describing it as a “massive epidemic”. However, older patients are as prone to the same conditions, such as heart attack and stroke, as they are in Ireland.

The stress and disorientation of travel can also provoke an episode of dementia in the elderly if they are borderline cognitively impaired.

“Accidents, mosquitoes and gastroenteritis are your three biggest killers,” he said. 

GPs were advised to allocate a half an hour, if possible, to travelling patients. They should be told about the importance of skin care and to take medication in blister packs when going abroad.

Unfortunately, only 30 per cent of patients visit their doctor before travelling and Dr Maguire urged those going abroad to avail of the European Health Insurance Card.

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