- All doctors need support - they just need it in different ways
- The doctor in difficulty has a broad definition with many different types of presentation that can include rigidity, ward rage, disappearing acts, poor decision making and career problems.
- Lack of engagement in educational processes indicates a trainee in difficulty.
- Cultural issues can be a significant barrier to performance.
- With the doctor in difficulty, you first need to define the problem. The performance triangle gives you aspects to consider.
- Early identification of problems and intervention
- Establish and clarify the circumstances and facts as quickly as possible. Use as many different sources of information as possible.
- Poor performance is a symptom and not a diagnosis - you must ascertain the underlying cause for the behaviour.
- Once you have diagnoesd the problem, develop an effective remediation. Different problems will require different solutions.
- Ensure you have clear documentation of all the interactions you have - just like a patient's clinical record.
- Communication is key and progression should be delayed until the issue is resolved.
A diagnostic framework for poor performance;
- Trigger event or incident is identified
- Investigate - if serious issue, then define the problem
- Decide if this is an individual performance issue or an organisational issue or both.
- Can they normally do it - if the answer is no, then this is a training issue and resolution may be possible with training.
- If they can normally do the task and can't do it now - ask why (clinical performance issue, personality or behavioural issue, cultural issue, health issue, environmental issue)
How do you make people change?
- Be positive
- Build and maintain trust
- Engage in reflective practice
Trainee needs to feel positive before you are able to make a change. Trainer needs to be self-aware when making a change.
When making a change, don't focus on the negatives and remain appreciative when dealing with the trainee in difficulty.
Prevention is better than a cure - get to know your doctors, have a good team atmosphere, create a culture of success, train and reflect.