Difficult decisions

Did you see the brilliant August Special Edition on Difficult Decisions? In case you missed it, there is a wealth of discussion around many different difficult decisions which regularly affect us.

I was really interested in the article ‘The ethics of GP commissioning’ by @gentlemedic, a Clinical Lecturer from Oxford University and Dr Cox, GP with special interest in Ethics and medico-legal work. I work for our local CCG and have to advise with a much wider population view so was particularly interested in this discussion, but also the ethics around the decisions we make to manage the care of our individual patients or practice population.

The great @DuncanShrew writes about the impact on us, of all the decisions that we have to make which was certainly a message which rang true with me. I have heard it said that as GPs we make a decision every 10-20 seconds  – whether to pursue that mention by a patient of chest pain in amongst the other plethora of symptoms, or in amongst a list of 80 medicines management is it ok to re-issue this medication, or whether to read the urgent screen message whilst the patient is in with us or wait until they have left. I remember on more than one occasion of getting home from a long day, my husband has asked if I would like a cup of tea and I have genuinely struggled to answer. Decision fatigue is very real for me.

The article ‘The psychology of uncertainty in difficult decisions‘ is a fascinating closer look at our reactions to the horribly uncomfortable moments of just not knowing what to do easily referred to as ‘WDYDWYDKWTD moments’ (What do you do when you don’t know what to do). The fear that if only a better doctor was seeing this patient or looking at these results because they would obviously know what to do. I recognise that I had these a lot as a trainee, and in no way do I now know all the answers, but having strategies for how to manage the situation is so very helpful. I couldn’t really understand this when my supervisor told me to learn how to manage the situation, it felt like a cop out, that actually we should just work harder to know all the answers. The realisation that we can’t and that our role is also to risk assess is both helpful and daunting. This article is a good opportunity to consider why we feel the way we do in those WDYDWYDKWTD moments. The following article then considers sharing this uncertainty with our patients.

There are also lots of shorter scenarios posing difficult decisions which are produced in partnership with RCGP and Doctors.net with the opportunity to post your thoughts in the discussion afterwards. These are available at http://journals.sagepub.com/Ino/tenminutescenarios?pbEditor=true