Flustered, much? : Decision making in Clinical Practice I
Sunday, October 26, 2008
Some people are always in a rush. The smallest thing becomes a huge problem. Everything is busy, they need to be somewhere, like five minutes ago. They can't sit still for more than a few minutes; there's always a question or directive on the tip of their tongue. Their manner spreads panic and uncomfortableness. And, when they leave, things are tense and agitated. The situation disintegrates. They are, in short, forever rattled.
Some people are never perturbed. They're so under control, they're relaxed in really stressful situations. Things appear to be a breeze, and the closest they get to really stressing about something involves the brief interjection 'Hmm' at the start of a sentence. The answer comes in good time, and it is well considered and comforting, it assesses the present, appreciates the past and plans for the future. They are, in short, unflustered.
When I first began team sports everthing felt like a rush (except fielding at cricket, of course). I'm a pretty keen sportsman, and, well, I'd put myself at above average coordination. Still, until I hit the age of nineteen I never felt like I had time on the ball. I was competent at drills and training, and now and then I'd have moments of serendipity. Generally, though, I'd marvel at my colleagues and 'the time' they had over the hockey ball, or at picking the gap on the rugby field. I could still do it, but well, things felt rushed. Most average sports-people have the set of issues; taking your eye off the ball, fumbling under pressure and the like. By second year Uni, my sports skillset had changed markedly. On the hockey field, many of the blokes I played against were a bit older (they didn't chase young 'uns), and I didn't feel pressured in the way I had at school. I matured as a player and had more time on the ball. I still ran around as I always had, but thanks to some sporting self-confidence, I could think about where the pass was going or 'hold up the ball'; I began to enjoy my hockey much more.
When I started as a pre-reg pharmacist, I went red a lot. Not at home mind, and not when I was doing mundane work like stocktaking. Only when I was doing 'Pharmacist' jobs. If there was a line-up of 'scripts, or making a cream or even selling paracetamol, I would turn crimson and get my mist on. Comparatively, I almost never went red when I was talking on the phone to patients. I rarely felt 'flustered' as such, but the apparent physiological response indicates otherwise; still, I didn't go about my business in a mad rush. As I approached Registration, I realised the flushing had gone. I rarely needed to look up doses and I could pick OTC drug-drug conflicts at thirty metres. I knew the answers to questions about Warfarin and other relatively complex interactions, and was able to rationalise the steps to each solution. Explaining concepts like blood pressure and allergies to Joe (? the Plummer) became part of my everyday thinking and communication style.
This post is the first of two in a series on Clinical Decision making. Predictably, making clinical decisions is one of the most challenging aspects of early practise in both medicine and pharmacy. Being able to weigh up the information for relevance and importance, then act on it. With time and experience one develops knowledge and understanding about the decisions they make. One must still remember the facts and reasoning behind their advice, and apparently, the more decisions you make the less red you turn!
Some people are never perturbed. They're so under control, they're relaxed in really stressful situations. Things appear to be a breeze, and the closest they get to really stressing about something involves the brief interjection 'Hmm' at the start of a sentence. The answer comes in good time, and it is well considered and comforting, it assesses the present, appreciates the past and plans for the future. They are, in short, unflustered.
When I first began team sports everthing felt like a rush (except fielding at cricket, of course). I'm a pretty keen sportsman, and, well, I'd put myself at above average coordination. Still, until I hit the age of nineteen I never felt like I had time on the ball. I was competent at drills and training, and now and then I'd have moments of serendipity. Generally, though, I'd marvel at my colleagues and 'the time' they had over the hockey ball, or at picking the gap on the rugby field. I could still do it, but well, things felt rushed. Most average sports-people have the set of issues; taking your eye off the ball, fumbling under pressure and the like. By second year Uni, my sports skillset had changed markedly. On the hockey field, many of the blokes I played against were a bit older (they didn't chase young 'uns), and I didn't feel pressured in the way I had at school. I matured as a player and had more time on the ball. I still ran around as I always had, but thanks to some sporting self-confidence, I could think about where the pass was going or 'hold up the ball'; I began to enjoy my hockey much more.
When I started as a pre-reg pharmacist, I went red a lot. Not at home mind, and not when I was doing mundane work like stocktaking. Only when I was doing 'Pharmacist' jobs. If there was a line-up of 'scripts, or making a cream or even selling paracetamol, I would turn crimson and get my mist on. Comparatively, I almost never went red when I was talking on the phone to patients. I rarely felt 'flustered' as such, but the apparent physiological response indicates otherwise; still, I didn't go about my business in a mad rush. As I approached Registration, I realised the flushing had gone. I rarely needed to look up doses and I could pick OTC drug-drug conflicts at thirty metres. I knew the answers to questions about Warfarin and other relatively complex interactions, and was able to rationalise the steps to each solution. Explaining concepts like blood pressure and allergies to Joe (? the Plummer) became part of my everyday thinking and communication style.
This post is the first of two in a series on Clinical Decision making. Predictably, making clinical decisions is one of the most challenging aspects of early practise in both medicine and pharmacy. Being able to weigh up the information for relevance and importance, then act on it. With time and experience one develops knowledge and understanding about the decisions they make. One must still remember the facts and reasoning behind their advice, and apparently, the more decisions you make the less red you turn!
