SBAR and me

3 02 2011

For those of you who don’t know about it, SBAR is a handy acronym used in the NHS (because if there’s one thing the NHS needs, it’s more acronyms </sarcasm>) that can be used communicating information. Now, I’d not stumbled on this little piece of of the interwebs before, and none of the hosptials I’d been placed in had used it. Until this year.

It’s now a month since I first heard about it, and thought it was time to reflect a little on my experience.

At a first glance, it seems kind of intuitive. Thie pieces of SBAR are:

S – Situation. Describing the current status/problem succinctly

B – Background. What has lead up to this? What are the salient points from the history?

A – Assessement. What have you done? What have you found? What does this tell you about what might be going on?

and finally

R – Reccomendations. SBAR as I’ve seen it has been used in handovers, so this is what the team handing over care recommend that the team taking over care should do.

There is a lot about this that I really get on with. It seems like a nice idea to begin with the key issue, sets the tone, allows the person you’re talking to to get a snapshot idea of what’s going on, particularly important in where patients have more complex histories or care issues. Often as I’ve come across patients being presented to colleages in the past, the order of the current situation and background may be flipped (as in “This is a x year old lady with a background of y and z, presenting with a”), so this has taken a little getting used to for me.

Another excellent aspect of the SBAR format is that it positively encourages doctors (in particular more juniour doctors) to engage in patient’s care more directly, by allowing them the opportunity (in fact, the format demands it) to make a management plan and vocalise it to others (the recommendation).

As well as handover, I have also been encouraged to use the format during an adrenaline fuelled simulation session, trying to get a registrar to come and see my increasingly sick (pretend) patient. Knowing that I was supposed to be using SBAR, and so was allowed to make firm recomendations to my senior (in this case, something along the lines of “drop what you’re doing and come help me NOW!!!!”) was very empowering!

However, even after amonth, something hasn’t quite gelled. I love the narrative of medicine. I love the descriptions patients use. I love engaging with people, and find it difficult to distill human interaction into a one line “neurology advised x”. Perhaps this is why I’ve always felt more of an affinity with the more narrative-based specialties (GP, psychiatry…) over the more ‘snapshot’ specialties. Without begining at the begining and working my way through, I know that I find it difficult to remember things. So SBAR can be something of a challenge.

In real life, we often come across several problems, and will solve some whilst still turning up new issues to be considered. This ‘disordering’, this natural chaos, is the environment my brain has learnt to cope with. To suddenly impose rigid barriers between the synthesising and exploration of theories feels artificial.

This is even more so in pressured situations. What I found with the simulated session was that my ability to synthesise the narrative of what was happening into an SBAR format felt nigh on impossible. Details bled away, my mind felt scrambled, and all I had to hang on to was “oh, I need to give my assessment now” rather than actually thinking about what information needed to be got across, what problems we’d encountered, and what steps we’d already taken to help the situation.

I am sure this is a tool that I will discover when it can be used well. I am sure I will also learn to use it at times I currently find difficult. But not today.

Jx





Things I learnt whilst intercalating

9 01 2011

Things learnt during my intercalation year:

1) That yoghurt is really easy to make-although does require youghurt to make it.
2) That giving traditional birth attendents cranberry juice will not cure their social phobias.
3) Facebook is the best procrastination tool known to man (well, students anyway).
4) That vital websites will always be down, email inboxes full, library books MIA and coffee machines without any cups the night before a deadline.
5) The hilarity of geeky stats jokes is inversely proportional to the time (in hours) since last using SPSS.
6) That research karma is real – I blame not filling in all those 3rd year PHP questionnaires for my response rate.
7) That “statistics is just REALLY hard” (pearl of wisdom, apparently).
8) That medcaf will never be able to meet the brownie demand caused by intercalators!
9) Not to advertise sexual preferences on emails sent to staff.
10) “It’s a fork” (otherwise known as assume makes an ass of u and me)





Factoid

8 01 2011

Fact of the day:

Hungarian Gypsies may only drink brandy at 3 points during the day: First thing in the morning, in the middle of the night at a wake, or by women prior to going on a rubbish scavenging expedition.

From http://www.sirc.org/publik/drinking6.html

Referenced to Stewart M. (1992). I can’t drink beer, I’ve just drunk water: Alcohol, bodily substance and commensality among Hungarian Rom. In D. Gefou-Madianou (ed.), Alcohol, Gender and Culture. London: Routledge.





Spark of interest

5 12 2009

OK, so I’ve been thinking a lot over the past week about how hobbies and interest wax and wane over time. This weekend I should be at a martial arts training thing. Now, it’s not that I don’t want to go exactly. I do. I know if I was there, then I’d have a great time. However (I thought this would write easier than ‘but’….turns out it’s the same thing!). I’m tired. The last time I properly was training I became ill. Then I had a bit of a knock to my complete lack of confidence. Et voila. I no longer feel the same spark I used to. I have no doubt that with rest, and a bit of a break, that spark will return. But for now, I just want to crawl into bed and not get out.

Which is partly why I’m so happy about discovering magic. Now, I’m not exactly new to this world, but the last time I really took it seriously, I was just a kid. I’ve kept a toe in the water, but it’s only really since visiting a wonderful magic shop with some lovely forum people 🙂 that I’ve felt that neccessary enthusiasm to actually go somewhere with it. These last few weeks, I’ve loved nothing better than curling up with whatever book’s just landed on my doorstep, and just absorbing. No pressure (yet), just learning and, more importantly, enjoying. I suppose my intention for writing this comes from a need to understand my thoughts in this.

I am glad I took this time to not learn some of this. In many ways, learning about magic takes something away. It reduces something impossible, something magical, into a trick. In some ways I feel saddened by this. It is a part of the lonliness that comes with the teratory. Yet the struggle to keep the magic alive for others is what drives people to magic. So the excitement returns, anew. And what an amazing thing that is!

Jxx





Teaching and learning

2 12 2009

Well today the tables were turned. As a student, I’m used to sitting in lectures, absorbing. Feeling something of a sponge, although knowledge rarely sticks beyond 24 hours, as it is wrung out to make room for the new! But that probably says more about my innability to remember than any fault on the lecturers part.

Today, however, was my turn.

I had 1 hour, 1 subject, and 4 eager students (well, 3 students and 1 GP) to impart knowledge and wisdom to!

Choosing a topic largely within my comfort zone, but also learning a lot in the process seemed a sensible direction to go. And in the end, I figured that by the time I’d left time for questions, and a fun game of snakes and ladders (with medical questions before anyone was allowed to move forwards lol), I only really needed 35-40minutes of material. This was fine, I could answer almost every little problem, and even took some time to explain how I remembered some of the equations involved. Lets just say I’m not usually a visual learner, but in this case I imagine a lady made of china and a yuppy in London (wearing a hat for reasons that make sense only to me!). Odd, but even odder is that it actually works!

Finally, as I’d heard that chewing improved memory (http://www.newscientist.com/article/dn2039-chewing-gum-improves-memory.html), I reassigned some of the chocolates I’d brought from the game to help with memory during the seminar parts of the session, in the hope it might help… well it kept them happy (and sugared up!), anyway! 

All in all, a success!

Jx