The Art of Reflective Practice
The New Year provides a useful opportunity for reflection on past events and allows time to plan for better things in the future. For someone in the medical field, these are opportunities to reflect on current practice and are something that the profession thrives upon.
Indeed the very nature and complexities of medicine demand that its life-long students must reflect upon what could be improved and attempt for a global push to take medicine to a new level. For when medicine steps forward, whether in research or in clinical care, the world steps forward with it, when medicine regresses or fails, the entire world suffers. Thus the opportunities for reflection are not restricted to the first midnight of the New Year for those in the trade. The dealing of life and death, the toying with people’s lives, and the somewhat ‘God-like’ decisions that medicine entails, requires that its students continue to reflect at every opportunity.
This takes me onto complaints. No seriously, it does. The western world has developed something of a complaints culture and medicine has not avoided this plight. Patients may find on entering a UK hospital, the Patients Advice and Liaison Service (PALS). This service, situated often next to the main entrance, allows patients to voice their concern, provides them with general information, and of course advises them on the hospital’s complaints procedure.
In the atmosphere of complaints, and with the fear of being sued, many health professionals view this service as intrusive to their practice. The complaints culture has meant doctors must dedicate a massive portion of their time to paperwork. In addition the fear of complaint has led to a reduction in the faith of clinical skills and a greater reliance on radiology to help direct medical management.
But are complaints something to be feared or a concept to be embraced? Complaints give the health service a unique perspective of what can be improved and allow the medical profession to improve by default. This perspective comes from the most important person in the medical team; the person who often has the ultimate say in the medical management and the person on which a health service would be massively flawed without. Of course I refer to the patient, but it is my belief that health professionals, particularly junior doctors in their high-flying moments, may often forget who the most important person on their medical team is, if indeed they are considered to be part of the team at all.
A justified complaint is the failure of medicine, whether this is in the research, or the clinical implementation. Medicine sets out to make patients feel better. If we don’t succeed at this then surely we have failed. And if we have failed, we must improve; the process of reflecting.
It is an odd and unfortunate part of many practitioners’ thought process that they only reflect on negative performances. When things go wrong, the limbic system must be coded to send off the messages to make you feel even worse, and hours are lost reflecting on this single terrible episode. Although painful, the said terrible episode rarely happens again. Evolution at work or God’s blessing or both, the point is we are able to adapt as a result.
On the rare occasion we remember that we have done well, we learn to acknowledge this and subconsciously repeat practice and achieve the continually high standards. Occasionally this breeds complacency but thankfully pioneers keep the process moving forwards. So in summary reflection allows us to improve. We all do it, whether it’s conscious or subconscious, written down or kept in the mind, liked or disliked. Is it a good thing? I believe so.
Medicine can be considered a science but the balancing of decisions and the frequently missing ‘right answer’ means it can be justified as an art. With split second decisions and ethical dilemmas creating a confusing canvas, it is only through reflecting and developing practice that medicine moves forwards. Taking a few moments in the mirror everyday allows a person to improve his appearance but that time reflecting may be just as well spent reflecting not on appearance, but rather on improving one’s own current practice. The question remains in my mind whether I have managed to convince my peers and superiors that reflective practice is of value. The decision will be made tomorrow morning in front of the mirror.
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