Like many better other folk, I am enthusiastic about teaching.
I teach medical students often, both on wards and in clinics and within the community as well as formal classroom teaching. I'm often asked to do some teaching outside our organisation, this month it's been within a GP surgery, two care homes and our hospice. But I also teach members of our teams.
Teaching small groups of nurses and social workers, student nurses, occupational therapists and support workers does give people the opportunity to ask about small things they would like to know about or clarify. It also means we can share new information. It's healthy for teams, I feel, since we can all get together and bat out our views on a topic and there's a sense of collective "buying in" or cohesion at the end of it.
This week I have been struck by just how much people learn within the working week :
- one nurse queried with me whether a patient we're seeing with atypical dementia (and still trying to formally diagnose what the problem is) could have Binswanger's disease.
And she's quite correct, it fits very well indeed, he may well do.
- one nurse student, on seeing a patient on an anticonvulsant who had recently been initiated on olanzapine, queried the dose. Starting at 5mg, she questioned whether the dose would be therapeutic because wouldn't the anticonvulsant mean that her cytochrome P450 would metabolise the olanzapine so there'd be less to work?
The answer was almost meaningless but it was the process, her thoughts on the medication and consequences of interactions, that was spot on . . . stunningly good thinking. We've titrated the dose up now but she was absolutely right that the patient was on an enzyme inducer.
- a social worker asked me if a younger patient who's been on donepezil for 4 years for Pick's disease should stay on it. It's working very well, but the patient's had a arthritis, has taken over the counter tablets since last year and now has heartburn and is being investigated for stomach ulcers.
An atypical diagnosis, impact of pharmacology on clinical care and knowing cautions of drugs we use. I'm really am blessed with such a good team.