1. *www.docrick.co.uk Life Stages (keeping the spark) Dr Mark Rickenbach FRCP FRCGP PhD FHEA GP, Trainer, Appraiser and Mentor* - Park and St Francis surgery Associate Dean Wessex Deanery Hon Professor University Winchester - Quality of Healthcare and Education * = search

2. *www.docrick.co.uk Positive automated thoughts*: “Enjoyed getting to know my patients well” “Continuity …satisfying” “Intellectual challenge and working with people” “Well paid, secure and interesting job” “Freedom of self employed” BMJ 9 th June 2012: Lessons from the class of 1970 /Life/positive thinking

3. *www.docrick.co.uk Case Discuss: Sam Sam: Core skills as trainee Registrar to GP transistion 10 (seven*) minute appointments Corridor* of 18 in surgery A patient (or a colleague, your role, yourself) My pyjamas, My mother * /medical../my pyjama.. /consultation/seven..

4. *www.docrick.co.uk Case Discuss: Sam Children - Priorities shifting Balance home and work 5yrs clinical focus – enjoyed

5. *www.docrick.co.uk Case Discuss: Sam Older, complex patients Complaint, practice issues Follow up visits, phone calls Wait to be seen Slower, Stay later/go early Frustrated Unsure if can manage Partner(s) concern

6. *www.docrick.co.uk Mask of relaxed Brilliance Coombs 1990

7. *www.docrick.co.uk

8. Proactive or Reactive GP*: Read, anticipate,prepare Pick up cues Deal with all issues over time Examine Ask if any other questions Ask if understood Ask if all covered Checks past records Makes a good record Problem list edit Template enter. /consultation/proactive

9. *www.docrick.co.uk Case Discuss: Sam’s “rising tide” Error pattern: management, diagnosis, prescriptions and communication Issues pattern: Quantity, quality, absentee, Centre of conflict, dishonest, unrealistic goals, refuse to delegate, slow decisions,

10. *www.docrick.co.uk Options? * Please discuss Pairs (2 mins) then group - Patient - Colleague - Mentor - Yourself /consultation/options

11. *www.docrick.co.uk Life Stages - “normal” Mid Life changes GP: Clinical – Practice – External Check: Physical illness – blood screen Alcohol Drugs Insight Clinical knowledge

12. *www.docrick.co.uk Life Stages - “normal” Self-discovery & Tentative Choices Young Adult Transition Making Commitments The Mid-Life Transition Leaving a Legacy

13. *www.docrick.co.uk Tips Negotiate list Workload* Delegate* Focused learning Fact management * LLAMA* Local Linked Addresses Management Advice /appraisal/handle workload /leadership/delegation… /medical practice/fact manage

14. *www.docrick.co.uk Tips Teamwork Belbin* Preferences Myers Briggs* Expectations high or low Values and vision Goals, Prioritise /appraisal teamwork.. /appraisal/myersbriggs

15. *www.docrick.co.uk External support Your GP, Partner, Colleague Career coach or Mentor “Wessex Insight” Counselling (eg CBT, NLP) Doctors help line

16. *www.docrick.co.uk Dr Nizam Mamoud 1999 Positive automated thoughts*: Recall the good times Secret of life:

17. *www.docrick.co.uk Appraisal Consultation skills video Primary Care Trust Clinical Commissioning Group Clinical Director NCAS National Clinical Assessment Service

18. *www.docrick.co.uk GMC: Insight?, history? Skills?, Knowledge? Workplace reporter Mentor GP Medical supervisor Psychological supervisor

19. *www.docrick.co.uk Generic Advice (4 points) Time off, time self Counselling Medication Exercise (but TREAD study BMJ 2012 334 p6 severely depressed no difference?)

20. *www.docrick.co.uk Now is your opportunity……….. Positive automated thoughts*:

21. *www.docrick.co.uk Questions?

22. *www.docrick.co.uk Being a GP “Enjoyed getting to know my patients well” “Continuity …satisfying” “Intellectual challenge and working with people” “Well paid, secure and interesting job” “Freedom of self employed” BMJ 9 th June 2012: Lessons from the class of 1970