I faced quite a challenging professional situation recently. I was on unfamiliar ground, on call in a hospital that I do not know particularly well, in a specialty that I am still very much a trainee (although with considerably more knowledge now than I had three months ago at the start of this rotation). The long and short of it was that the nursing staff were keen for me to alter the management plan for a patient and I was not keen to oblige. My professional instincts were that the suggested change of medication may well have been a better plan in the long run but it was not appropriate in an acute setting. I was certainly not the appropriate person to be making those changes in that specific situation. I stuck to my guns and was relieved and reassured that when I discussed the situation with my clinical supervisor, he was entirely in agreement with the way I handled things.
Advice from specialist nurses in a specialist setting is certainly an important part of management planning. I absolutely do not subscribe to any outdated thought that simply because I am a doctor, I know best. However, I came away from this situation reminding myself that ultimately I am the one who takes responsibility for my professional actions. I sign the drug chart, I give the authorisation for any management changes, I decide on how much I delegate to others in terms of when to act and what to do, especially concerning “as required” medication.
In General Practice there are many other pressures. Some parents will insist that their child should receive antibiotics. Some patients demand to have a scan or specialist referral and there are plenty of relatives who constantly question the treatment of their elderly mother or father. The government sends directives about what must be monitored and measured and financial and professional penalties apply if they are not completed. Time (or the lack of it) adds in another pressure and a temptation to take the path of least resistance is always there as the “devil on your shoulder” when all of these pressures start to weigh down.
My key point in this blog is the one I mentioned earlier. I retain responsibility for my professional conduct. Ultimately I need to be prepared to justify anything I do to the GMC and a panel of my peers. I also need to be able to reassure myself at the end of the day that I have genuinely tried to do what is best for my patients and resisted any pressures to take the easy option.