Identifying difficult situations
Identifying that there is a difficult situation (emotionally, not biomedically) is the first step.
The main warning sign is when a patient elicits an unwanted feeling in you, like annoyance, embarrassment, a heart-sinking sensation, powerlessness, loneliness, confusion, anxiety, frustration or even anger.
The ‘feeling’ words used to describe a case are a clue that there are important relationship issues that won’t be resolved by discussing biomedical aspects alone.
Structuring a discussion
The structure of the discussion is important. First, the GP presents the case to the peer group, in five minutes or less. The group members listen with respect and without interruption.
The GP outlines the medical context briefly, moving quickly to the main focus: a rich and detailed description of the patient, the setting, their interaction with the GP, perhaps with details of a particular consultation and how it felt at the time.
Useful additional comments include answers to questions such as: how does it sit with you? What’s the ‘pointy bit’? What does all this mean for you as a doctor at the moment? Being honest about the challenges to your composure is key.