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The annual British Social Attitudes survey has now reported its conclusions on the UK public’s level of satisfaction with the NHS in 2015. There’s a significant disappointing shift compared to the previous year’s results.  Overall levels of satisfaction have declined and levels of dissatisfaction have increased. You may, or may not be surprised.

As a result, it would be very easy to create a piece of writing here which would be in very stark contrast to the blog we posted in response to the 2014 report at this time last year.  That post had the headline ‘Dare to be optimistic in the NHS?’  The previous 2014 report found satisfaction to be at its second highest level ever and with the lowest ever reported level of people who stated they were dissatisfied. The title ‘Dare to be optimistic in the NHS?’ ended with a deliberate question mark. It went on to explore the subject of the implications of optimism and pessimism.

This new blog post will deliberately be neither uplifted nor downcast by the latest 2015 satisfaction report. Instead we will consider the differences between facts and opinions and how this has relevance to everyday leadership.

The British Social Attitudes survey’s conclusions emphasise that ‘public satisfaction cannot be interpreted as a straightforward indicator of NHS performance’. However, when the figures improve the Government of the day will claim the results as a triumph of their actions. In sharp contrast, any decline will be used by the opposition to robustly challenge the present policy-maker’s direction and decisions. This would appear on the face of it to be a valid course of action in each case.

Public Satisfaction with the NHS in 2015 collates the opinions of a sample of the population. Some of the survey’s facts which may be worth taking note of include:

• The percentage ‘very or quite satisfied’ was statistically higher in the 75+ age group compared to respondents 18-34.
• The score for ‘very or quite satisfied’ was higher for those who had experience direct contact with NHS in-patients over the past year.

These points are interesting when you consider the population aged 75+ are more likely to have had treatment than the younger age group. Could there be a difference in expectations? Could the younger group were observing factors in the care of their grandparents that they were not happy with? Could there be other factors at play?

Returning to the political arena there was a ten percentage point drop in ‘very or satisfied’ amongst Labour voters, whereas there was very little change in the opinion of Conservative voters and even a small increase with Liberal Democrats – despite their party no longer having any direct influence in government.

We also have to bear in mind that Labour voters reported an 11 percentage point jump in 2014’s survey compared to the previous year and that there is a 95% certainty level claimed the data. Pollsters can and do get it wrong – look at last year’s election and others from recent history. Could it be that nothing has actually changed at all? Should such reports just be ignored as yet another meaningless bit of NHS bashing?

Well that’s a matter of opinion! 

Medical leadership involves engaging others in opinion development on a daily basis, particularly when dealing with motivation and influence. We offer our opinions and, ideally, we listen to and work with theirs. Unfortunately it is human nature that we often fall into the trap of the confirmation bias. Both leaders and those we are trying to influence can be guilty of forming our initial opinion, then seeking out facts to support this. We then interpret any other facts which we encounter according to whether we believe they confirm or clash with our preconceived notions.

However, doctors are trained to practice evidence based medicine: to determine and work with the hard facts; to identify patterns, connections and implications; consider valid options and then choose the correct course of action in their opinion.

Opinions which are not based upon sound fact can be problematic in numerous ways. However when we move into the arena of medical leadership, the opinions of those that we seek to influence are themselves facts – regardless of how they have been developed. It is a fact that they hold their opinion and we have to work with this if we are to make progress.

How does the evidence based medicine approach compare to the way that you seek to engage the opinion of others beyond decisions which are related to direct individual patient care?

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services

The funding of the NHS is a political hot potato. It has been a contentious issue even before the service first launched way back in 1948. Points of alignment between opposing politicians, doctors, tax-payers and patient representatives have been few and far between. Not only do we have disagreements about how money comes in but also how and where it is spent. As a result we have all four of the home nations – England, Scotland, Wales and Northern Ireland – on very divergent paths. How should we pay our doctors? How should we organise funding of hospitals? How should we organise decisions about what services to offer?

Healthcare is an arena for stunning innovation on a regular basis. It may even be that the pace of these innovations is accelerating and with ever increasing momentum. The possibilities are incredible – yet the associated challenges seem increasingly insurmountable as uncomfortable, painful dilemmas come into focus.

At the end of January The Lancet Oncology reported a study that proton beam therapy is as effective in children as conventional radiotherapy, and has fewer side-effects. You will remember that this is the treatment at the centre of the highly emotive 2014 Ashya King controversy. On one hand this is fantastic news. On the other, innovations of this nature lead to big questions: money, staff numbers, time and space available are all finite resources.

How much will the equipment for this new equipment/treatment cost to purchase? What are the associated costs of training doctors/operators/technicians? How often will it be used? Even if we can afford to buy the equipment how do the running costs/treatment times compare to what we currently have? If we do purchase it then where will we put it? Does something have to be moved out to make way? What will we do with the patients that were best served by that treatment method? What else do we need to consider?

Shona Robertson, the Scottish health Secretary announced an independent review of the ‘value for money’ assessment process for drugs in Scotland on the same day that the proton beam therapy study hit the news. At the end of any such assessment, the fundamental economic decision which has to be made sounds uncomfortably harsh: ‘We know it will help this patient – is it worth it?’ How can we comfortably make such decisions?

The field of economics is more than pound, shillings and pence. It is ‘the social science that describes the factors that determine the production, distribution and consumption of goods and services.’ Clinicians of all disciplines actually make decisions of this type on a daily basis. An example is the decisions on how much time to spend on a particular patient. We know that there could be direct benefits for the individual if we give them more time – yet there are only so many hours in a day and there are other patients. So we have to curtail the time dedicated to this individual in order to provide a quality service to the many. The decisions about approval for new treatments may seem remote as they are made in a different forum than daily, direct doctor-patient interactions, but they are fundamentally the same type of decision.

News stories of innovation, new techniques and therapies still have a very real day to day impact upon doctors in practise. They have a direct impact upon patient expectations and those of their relatives.

In addition to the decision making process itself, the Scottish independent review of the ‘value for money process’ would do well to consider the approaches to consultation and communication of decisions with all stakeholders: the fund-holders and hospitals; the doctors who will/will not be able to utilise the technique or therapy; the third sector and, of course, the media.

At the same time, doctors must continue to develop their abilities to have to factual, empathetic conversations related to economic decision with patients and relatives. Active interaction with an ‘value for money approval processes’ can only support this development.

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services

I recently had a discussion with a doctor – let’s call him Dr John – as part of our support for his preparations for a forthcoming Consultant Interview.  Dr John was delighted to have been successfully included on the shortlist for a position in his ideal location.

In line with common practice he had tried to arrange a pre-interview visit to the department.  The initial approach of sending emails met with no response.  Considering how busy everyone is at this time of year in particular this was disappointing but potentially understandable.  So Dr John decided to drop into the hospital on his day off.  He found the reception/admin team members to be very friendly and accommodating and they organised time with a senior member of the team – let’s call this senior colleague Mr Brian.  They also said that Dr John was welcome to have a look around.

As you may expect, everyone was very busy so Dr John had a few brief, passing chats with a couple of the team members without really learning anything.  He then headed to the Mr Brian’s office and waited for their scheduled meeting.  Mr Brian was over 20 minutes late for the meeting and seemed more than a little irritable when he arrived.

Dr John was aware that the organisation’s recent CQC report had been less than favourable, in particular in relation to events in this particular department.  He tried his best to tactfully raise the subject, asking some carefully considered, relevant questions.  In addition, he asked if he could arrange a meeting with one particular member of the team in order to find out more about the challenges of the role ahead.

The requests met with a hostile response from Mr Brian who, according to Dr John, became particularly unhelpful, negative, defensive and obstructive.  Mr Brian stated firmly that he would not be arranging access to the particular team member that Dr John wanted to speak to without explanation.  He even went so far as to say that Dr John’s approach was both unprofessional and unethical.

Dr John was understandably confused and alarmed.  He described his questions to me and the words which he had used.  I had to agree that if this recollection was correct the he had been entirely reasonable.  Dr John was now questioning whether he wanted to even go for this interview as his impression was that Mr Brian was an unreasonable, over-controlling person, that there was something to hide in the department and that he could not trust his potential senior colleague.

The events reminded me of a point which we regularly discuss at our Advanced Team Communication Skills Course for Doctors:

Why are other people difficult?

We all encounter colleagues behaving in ways that we find a difficult from time to time.  Before trying to work out the best way to deal with the situation it is always helpful to be clear in your mind what is actually going on.  Just like medical practice, the best way to be able to effectively manage the situation is to diagnose the root cause of the problem.  There are two distinctly different possibilities:

1. We are dealing with the normal behaviour of someone that we find difficult.
2. We are dealing with a ‘normal’ person’s behaviour in difficult circumstances.

What will work as ‘effective treatment’ for one cause may actually make the other worse, even when the symptoms appear the same.  Choosing the best course of action requires the developing knowledge of different personality types and communication styles, as well as knowledge of the impact of stress and numerous other factors on behaviour.

Mr Brian had unfortunately created a poor first impression upon Dr John which can have a lasting effect which will be very difficult to change.  Our beliefs about expected behaviour and our associations are fundamental to our level of trust.  Trust is fundamental to the development of a Healthy Team.

In the end, having considered the possible reasons for Mr Brian’s behaviour, and bearing in mind the probable stress associated the current situation, Dr John decided he had nothing to lose.  He decided to go ahead with the interview, utilising the experiences of his visit to support evidence for his responses to interview questions if appropriate.  His honest, factually based answers would either impress the panel or will help confirm that he and the department were not a good match at present.  I’ll maintain confidentiality here, other than to let you know that Dr John was more than happy with the eventual outcome of his interview.

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services

Agreement between Jeremy Hunt and the Junior Doctors’ representatives to meet at ACAS in an effort to resolve the current pay dispute comes as no surprise.  Both sides appear to be maintaining an aggressive mindset.

For regular readers of Oxford Medical Training’s Insights Blog we have been regularly commenting on the development of the crisis, exploring what doctors can learn from this that they can apply to their everyday leadership and team interactions. In our post Kubler-Ross, Doctors and the 7 Day NHS for example we predicted that ‘Bargaining’ would be the stage to follow ‘Anger’.

What impact is ‘Bargaining’ likely to have on outcome of the ACAS talks.

Back in the 1970’s, a time renowned for strained industrial relations, Thomas and Kilmann described five key approaches which people take in conflict situations: Avoiding; Accommodating; Competing; Compromising and Collaborating.

Neither party in the current dispute would appear to be interested in Avoiding or Accommodating -where they would be prepared to concede to the other regardless of the rights or wrongs.  So that leaves Competing, Compromising and Collaboration.

Competing behaviours– being confrontational, assertive and uncooperative, making declarations, demands and seeking apologies – are likely to lead to hardening of positions, entrenchment and further anger until eventually someone ‘loses’.  Relationships could be broken beyond repair.

Compromising behaviours, where the two parties effectively trade with each other – I’ll give up this if you give up that – may sound a more reasonable and appropriate approach, especially when the ‘Bargaining’ mindset of the change cycle is in play.  The danger here however is that the actual compromise reached is effectively ‘the worst of both worlds’.  No-one will be happy but both will walk away with agreement to move forward.

Collaborating behaviours are by far the most productive.  Unfortunately they are often the most difficult paradigm to adopt – particularly if the opposing party appears to have little appetite for this.  In true collaboration, both parties treat the conflict as a problem which they can only solve together.  This may mean starting from scratch by defining and agreeing honestly and openly about what is important and why, then proceeding to create something new.

On a personal level, each of us can have little direct impact upon the ACAS discussions.  We can however consider our own approach to conflict in our daily work.

Which approach do you use most often: Avoiding; Accommodating; Competing; Compromising; Collaborating?

What is the impact?

Which approach could you use more?

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management,communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services.

News that disciplinary action is now being taken against EU doctors over English language skills prompted an interesting discussion at one of our regular Teach the Teacher Courses for Doctors last week.

The initial focus of the discussion was around the subject of assessment: why should doctors be assessed and on what; where, when and how should assessments be conducted; what are the pros and cons of assessment?  There was general consensus that every doctor must reach basic standards for a broad spectrum of knowledge, skills and attitude.  Increasingly higher standards should apply progressively with advancing seniority and specialisation.

So far this is straight forward and obvious.  However, we then progressed to more thought provoking questions.

When is it acceptable for a doctor to settle for the basic level?  When is adequate good enough?

After a range of opinions were expressed there was general agreement that time limitations inevitably lead to the need for prioritisation of development.  The drivers of this prioritisation would be the subject matter and skills which have the greatest relevance to the individual – but how to determine relevance?

Daily pressures to accurately examine, diagnose and effectively treat patients require solid comprehension of anatomy, physiology, aetiology, pharmacology and more, plus a large number of practical skills.  This creates explicit demands to develop both scientifically and technically.  Revalidation should now be acting as one of the drivers for doctors to broaden this developmental focus.  Good Medical Practice exists as a framework to positively guide every aspect of science and practice to support this.

The EU doctors who have been subjected to action for their language skills are failing to meet the basic standard.  Few doctors limit their aspirations to being adequate.  But how many are settling for adequate in their command of the English language?  With more than a third of doctors having gained their Primary Medical Qualification outside of the UK, how many have taken steps since reaching the ‘basic’ standard have taken steps to further develop pronunciation, cultural awareness and comprehension of the nuances of language and gesture?

In which areas of practice are you settling for ‘adequate’

What steps are you taking to continue the development of your communication skills?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview preparation and teaching skills in the medical environment.  Our new one day intensive Improving English Language Skills Course for Doctors is now available for bookings.

With Government/doctor politics dominating the media’s health agenda in recent times, other stories easily to slip past without much fanfare.  One such example was the report on the BBC that one million pounds was being invested by researches to identify why patients disregard their doctor’s advice.

It is believed that up to half of medications prescribed for long term health conditions are not taken properly.  One of the most obvious costs of the failure to follow advice is the direct waste of providing these medications.  In addition, patients fail to control or resolve their health issues with the heightened risk of complications.  This inevitably leads to more appointments with their clinician with the associated costs that this involves.  Failure to follow their doctor’s advice leads to poorer health outcomes and inconvenience for patient, impacts on the doctor’s availability to others, waste’s money on unused medications and ultimately causes dissatisfaction and frustration all round.  Investment of £1 million in that context seems to make sense.

It will be interesting to read the project’s conclusions when they are available, as this will be a great help to clinicians.  If we understand the reasons then we can adapt to make improvements.  In the meantime the reasons for ‘non-compliance’ that we use as a basis for discussion during our Advanced Patient Communication Skills Course can provide useful guidance.

In a study from 1990, Sokol et al concluded the three key reasons for non-compliance to be:

• Reason 1 – The patient does not understand what they are supposed to do
• Reason 2 – The patient knows what to do but chooses not to
• Reason 3 – The patient knows what to do but is unable to act upon the advice

In the first case, the most obvious cause would be that the patient has genuinely not been given the information they require.  However this category also includes where the patient has not ‘heard’ the advice for some reason – even when they have been told.  The message may have been too complicated, didn’t make sense or could have been delivered at a time when they were stressed or distracted.

The drivers of the second reason, where the patient knows what to do but chooses not to, are distinctly different:  “It won’t happened to me”; “It’s not that bad”; “I don’t want to” or even “I don’t agree with the advice” are all possibilities here.

In the third category, where the patient knows what to do but is unable to follow the advice, the challenges range from difficulty breaking old habits, remembering when to take the treatment, struggling to fit it into their lifestyle or even be due to physical limitations.

The first step to resolving any one of these issues is to identify what is at the root of the problem.  Once clarified, the appropriate conversation will differ significantly for each situation.

It will be interesting to see how the output of this new £1 million study differs from this model.

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services.

The Care Quality Commission’s State of Care 2014/15 reports that three quarters of hospitals and one third of GP services inspected so far had problems with safety.  If you listen carefully you will be able to hear the general public’s alarm being drowned out by the wall of groans of doctors up and down the country.  Is this another crisis to be heaped upon an already demoralised workforce?

It would be easy to adopt Henry Kissinger’s glib comment: “There cannot be a crisis next week.  My schedule is already full,” and carry on regardless.  You may be familiar with some colleagues who will take on the ‘head in the sand’ approach or others who will shake their heads in the belief that we are facing a hopeless future.

Yet within the report there is real cause for optimism.  Of 123 services that were re-inspected within a year of the original rating, 50% demonstrated measurable improvements.

Kissinger’s quote was made with his tongue firmly in his cheek.  An alternative quote, which may sum up the attitude of the people who were involved in making these significant differences comes from another US politician, Rahm Emanuel, Mayor of Chicago: “You never let a good crisis go to waste.  And what I mean by that is that it’s an opportunity to do things you could not do before.”

A crisis can lead to realisation that change is required; create focus and initiate momentum.  A crisis can prove to be a powerful catalyst.  However if the energy created is neither harnessed or channeled then, as with any catalytic reaction, an initial burst of noise, heat and light will result in not much of anything changing long term.

The CQC report identifies one of the three key factors which play a critical part in quality improvement to be ‘Engaged leaders building a shared ownership of quality and safety’.

If leadership is the key, then who are the leaders?

During a workshop at a recent conference that I attended a junior doctor asked the group “At what stage of her career should I start to consider developing my leadership skills”.  In response, a senior doctor sagely advised her to concentrate on her clinical development and then to start thinking about leadership when reaching consultant level.  This may be a common opinion – but how appropriate is that viewpoint?

The NHS Leadership Academy Framework states that ‘The Leadership Framework is based on the concept that leadership is not restricted to people who hold designated management and traditional leadership roles, but in fact is most successful whenever there is a shared responsibility for the success of the organisation, services or care being provided.’

In other words acts of leadership can come from anyone in the organisation.  As a model it emphasises the responsibility of all staff in demonstrating appropriate behaviours, in seeking to contribute to the leadership process, to developing and empowering the leadership capacity of colleagues.  Where tasks are complex and highly interdependent this idea of shared or distributed leadership is recognised to be more effective than simplistic linear hierarchy.

With this is mind it is better to start developing leadership skills as early as possible.  They need to be nurtured and grown over time and with experience.  Senior doctors can support juniors through mentoring and enabling with delegation, encouragement the offering opportunities.  This may mean a change in style of leadership for these senior doctors.  As a direct result this may include the need to change and redevelop their own leadership skills.

Leadership is a multifaceted collection of human behavioural skills which both deserve and require proactive, life-long developmental focus.

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment through our courses, distance learning and one to one bespoke services.

At Oxford Medical Training we support thousands of doctors each year through our training events, programmes and materials.  We continue to develop the services that we offer you and have now added the following events to our calendar.

• Improving English Language Skills Course for Doctors
• Consultant Interview Course now launched in Glasgow
• Our Advanced Communication Skills Courses now available in Glasgow
• Oxford Medical Training at the BMJ Careers Fair

 

Improving English Language Skills Course for Doctors

During our Advanced Communication Skills Courses it often becomes clear that it can be a doctor’s confidence and skill with English language or understanding of UK culture which is having the greatest impact upon their interactions with both patients and colleagues.  This can lead to frustrations between colleagues and can inhibit the doctor’s career progression.  Most importantly patient care can be both impacted both directly and indirectly.

In 2014 the GMC amended Good Medical Practice  to include the following statement:14.1 ‘You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.’  In addition their new powers under the fitness to practice procedures include ‘to make sure all doctors are able to communicate in English well enough to treat patients safely’.

Doctors must now achieve level 7.5 in the ILETS examination to be accepted on the GMC register.  Though ILETS level 7.5 sets a basic standard it does not necessarily equate to confidence and fluency.  Continued Professional Development should cover all aspects of a doctor’s practise and it would not be considered acceptable to settle for ‘basic level’ on any regularly employed skill without refresher or effort to advance.  Good application of the English language is a fundamental skill which underpins all aspects of practise.  For this reason we have now introduced our new Improving English Language Skills Course for Doctors.

This interactive 1-day course is designed and delivered by an experienced English teacher to support doctors who feel they would benefit from improving their confidence in spoken English and their grasp of the English language.

Our first delivery of this course will take place on Saturday 21st November in London.  Spaces are limited to 12 delegates at each course so book your place early to avoid disappointment.

Click here to find out more about our new Improving English Language Skills Course for Doctors.

 

Consultant Interview Skills now available in Glasgow

The Oxford Medical Consultant Interview Course is renowned for preparing doctors to present themselves at their best, maximising your opportunity to secure your desired job.  With a focus upon developing your ability to articulate your thoughts and opinions with a videoed (optional) mock interview with feedback we have been running these events for over ten years.  Current locations are London, Oxford and Nottingham.

For the first time we can now offer this course in Scotland.  We have remodelled the NHS workshop section of this course to specifically support doctors preparing for a Consultant interview in Scotland.  This adaptation has been completed by working with a very experienced Medical Director.  Information to outline the structure and direction of NHS England will also be included in the course materials.

The first event will take place in Glasgow on Saturday 21st of November.  Spaces are limited to 8 delegates at each course so book your place early to avoid disappointment.

Click here to find out more about our Consultant Interview Course.

 

Advanced Communication Skills Courses now available in Glasgow

We now offer three options in our Advanced Communication Skills range of courses.

• Advanced Team Communication Skills Course for Doctors – 1 day
• Advanced Patient Communication Skills Course for Doctors – 1 day
• 2 Day Advanced Communication Skills Course for Doctors – saving on the delegate fee when you attend the two courses above on consecutive days.

At these courses we explore the key elements of good communication, the factors which affect behaviour and the practical application of communication models in healthcare.  Following on from the courses’ popularity in London we are now launching them in Glasgow.

The first events take place on the weekend of the 7th and 8th of November.  Spaces are limited so book your place early to avoid disappointment.

Click here to find out more about our Advanced Communication Skills Courses for Doctors

 

Oxford Medical Training at the BMJ Careers Fair

Oxford Medical Training will be at the BMJ Careers Fair which takes place on 23-24th October at the Business Design Centre, Islington, London.  With over 90 exhibitors, a choice of seminars and associated events taking place, why not come along and meet us at Stand 39.  You will be able to find out more about our services and special offers.  We would also love to hear your thoughts and opinions about the new courses and distance learning materials that we have in development.  We look forward to meeting you.

Click here to find out more about the BMJ Careers Fair.

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication, interview and teaching skills in the medical environment.

 Immigration is without doubt one of the most contentious subjects in the news over the past couple of months.  Earlier this week Home Secretary Theresa May stated thathigh levels of immigration make it impossible to have a cohesive society.

Whatever your views on the matter, immigration undoubtedly has direct implications to practising as a doctor.

At present some 13% of the UK population were born abroad.  At one level this ethnic diversity and demographic change means that today’s doctors are required to address different medical challenges than their predecessors – higher prevalence of diabetes in some localities or sickle cell anaemia are a couple of examples. On another level language barriers and cultural differences can lead to the challenges of effective communication with both patients and their families.  I know some clinicians working in areas where there are significant communities who have taken the practical step of learning the relevant language to address the challenge.

According to the General Medical Council’s statistics 36.4% gained their Primary Medical Qualification outside of the UK.  This figure rises to 41.5% for those on the specialist registers.  By implication the diversity of nationality is considerably higher within the community of doctors in the UK than in the general population and this has been the case for some time.  Such diversity brings both great benefits and great challenges.

The subject of cultural differences and language barriers – both between doctor and patients and between doctors communicating with each other – is a regular topic of discussion on ourAdvanced Communication Skills courses.  These events successfully focus on the principles of good communication, the factors affecting communication/ behaviour and the application of communication models to healthcare.  What often becomes clear, however, is that it can be a doctor’s confidence and skill with English language or understanding of UK culture which is having the greatest impact upon their interactions with both patients and colleagues.  This can lead to frustrations between colleagues and can inhibit the doctor’s career progression.  Most importantly patient care can be both impacted both directly and indirectly.

In 2013 the GMC amendments to Good Medical Practice includes the following statement: 14.1 ‘You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.’  In addition their new powers under the fitness to practice procedures include ‘to make sure all doctors are able to communicate in English well enough to treat patients safely’.

Doctors must now achieve level 7.5 in the ILETS examination to be accepted on the GMC register.  Though ILETS level 7.5 sets a basic standard it does not necessarily equate to confidence and fluency.  Continued Professional Development should cover all aspects of a doctor’s practise and it would not be considered acceptable to settle for ‘basic level’ on any regulary employed skill without refresher or effort to advance.  Good application of the English language is a fundamental skill which underpins all aspects of practise.  For this reason we have now introduced our new Improving English Language Skills Course for Doctors.

What steps are you taking to improve your communication skills and cultural awareness?

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication ,interview and teaching skills in the medical environment.  Our new Improving English Language Skills Course for Doctors is now available for bookings.

In a recent Insights post we explored whereJeremy Hunt may have gone wrongin his efforts to force a 7 Day NHS with greater availability of doctors at the weekend.  In this post we will look at this issue from the experience of doctors, relate this to the work of Elizabeth Kubler-Ross and then consider the implications for your daily practise.

You may well be familiar with the work of Elizabeth Kübler-Ross, an American psychiatrist and an expert in near death studies who wrote the seminal work On Death and Dying.  In this book she defined the five stages of grief  that have shaped the thinking surrounding how people deal with unpleasant and unwanted developments in their lives for many years.  The five stages of denial, anger, bargaining, depression and acceptance are illustrated at the top of this page.

The basic principle of this cycle has been widely adopted and adapted in many fields to describe the human reaction to imposed change.  Many writers have interpreted the five stages with different labels into numerous versions of the ‘change curve’.  At Oxford Medical Training we utilise these models in a number of our courses – during ourmedical leadership and management courses as well as in our communication skills courses for doctors. The basic principle is that it is necessary to progress through each stage in order to reach a genuine state of acceptance.

We can easily relate this to the reactions of doctors in the face of the demands for a 7 Day NHS, increasing the number of doctors in work at the weekends.

Denial – The first reactions were that this is unrealistic – it cannot and will never come to reality.  Focus was upon gaps in the argument with the validity of the data used to support the drive questioned.

Anger – Anger can be expressed in many forms, from emotional outbursts to militant behaviour.  In this case we have witnessed the #ImInWorkJeremy campaign on twitter from doctors who argue that they are providing a service and feeling unappreciated.  There have also been petitions supported by hundreds of thousands of signatories with stinging open letters from organisations and high profile collectives.

Bargaining – In time, assuming that the government does not back down, there will be a desire to move forward in some way and resolve issues.  It is likely that the desire to be constructive and find solutions will lead the representative bodies of doctors to engage in discussion and make counter proposals to find alternatives.

Depression – Should the demands for change continue we can expect a realisation of inevitability to grow.  It is likely that many doctors will experience feelings of despondency, reducing their communication as they reflect internally, trying to come to terms with the implications of the new situation.

Acceptance – The end stage of the process – again assuming that change materialises – is that doctors will start to look for new ways to adapt their work, social and family arrangements to find a new balance.

Being mindful of this model and maintaining honest, self-awareness of where you are on the curve can shift perception from being a victim to being in control.

Much of the wider UK culture has already shifted to 7 day weeks – shopping, services, leisure and entertainment – with the majority of us enjoying these arrangements to a greater or lesser degree.  As a result, we all have friends and family members who have experienced similar changes to their working arrangements to those which are being proposed.

A lot can be learned from finding out about the implications to their lifestyles – how have they adapted; what have they gained and where have they had to make compromises.  This can help you to move through the curve.  Of course it is still important to engage fully in the debate about the changes with those who have influence to ensure that the best outcome for all interested parties is achieved.

The demand for weekend working and the 7 Day NHS is just one example of change that will be impacting on your day to day working practise.  Forces of change are constantly at play, though they may not always be so fundamental.  Some of these changes will be imposed – driven by your senior colleagues, other departments or regulators.  Others may actually be driven by you.

When we are the drivers of change we will typically feel positively energised and can be confused or frustrated by the reactions of others to our initiatives.  In these cases we will be experiencing the cycle from the other side and recognising this has many benefits.

Awareness of the cycle of grief can both shift us from feeling like a victim to being in control and can also help us appreciate the reactions of others, resulting in more effective leadership for change.