Thursday, 28 August 2008

MDT Teaching

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.


Anonymous said...

Your post reminds me of tales from my parents. They were fortunate enough to be nursing in the 60's when learning disability nursing was starting to make some rumblings into new ways of treatment. What they didn't realise was they were working for one of the world's leading psychiatrists in the specialty and they got to try out some novel and wonderful things - like not locking them indoors all day! The advent of antispychotics in the previous decade also made for decreasing some of the more serious behavioural problems and freeing up so much time they were able to do more things around quality of life. By the time they'd realised the advances they'd made they were became something of an icon and were considered the best hospital in Europe.
Of course... that's what they tell me.

Socrates said...

Please come and work for OldPoshShire Foundation Trust and bring your team with you...

XE said...

Much goodness :P

The Shrink said...

Today I had a nurse talk with me about a patient we're managing in a care home who's developed visual hallucinations.

The nurse explained to me the nature and quality of the patient's experiences, "so it's not like Charles Bonnet syndrome, and medication could be useful.

I work with such clever folk!

Anna O. said...

I am so impressed with your team! Our team are lovely but not sure many of them would make those connections. Always good to have people like that to keep you on your toes!

ditzydoctor said...

wow! that's highly impressive :)

Cat said...

I think most teams want to learn and be better at what they do. I hope that this is the case in most MDTs, it certainly reflects my experience as well.

Milk and Two Sugars said...

Oh dear, no, not better at all.

That your staff know so much about the care of their patients must reflect both their dedication to learning and yours to teaching. It's lovely to hear about all of you, as an example of what might be if we decide to work for it.