In light of recent court cases where reflection has been using as evidence should we continue to direction of reflection on our practice? Yes, but with caution.
This is a result of a recent question that came into Fish TV episode 5. If you haven't seen any Fish TV yet stop reading this and watch the video below!
An article in the BMJ Careers, Written reflection is dead in the water, discusses the case of a junior doctor's written reflection being used against them in a court case. This seems very frightening when we are increasingly encouraged to reflect on learning points and how we will change our practice. Does reflection by it's own definition not admit ignorance or room for improvement?
There is no simple answer to this. In Reflection: how to reduce the risks the authors (legal advisors for the Medical Protection Society) suggest seeking legal advice before releasing any learning information. I worked for 3 years as a Medical Director for Wessex LMCs* and would strongly advise any health professional involved in a complaint, performance procedure or legal case to seek advice from their indemnity insurance organisation early. They also reinforce the importance of anonymising and patient information in our reflections. They state that evidence may not admissable if it is not identifiable. We must recognise however that some incidents are identifiable in their description or individual nature.
Hindsight is a wonderful thing. Reflection is not supposed to be a documentation of what we wished we had done differently but more using a learning framework to factually look at learning points and how we might change our practice. This may be to change a system or our own knowledge but it does not mean it is "better" and only continued reflection can help with this.
This court case has highlighted an important issue. The shift in encouraging reflection has been quite a marked direction change for health professionals in the last 10 years. We are well practiced at safety netting our verbal advice and written records in medicine and the same skills should be used when documenting learning.
The GMC remains clear that doctors should regularly reflect on their performance. A large focus of Revalidation is about demonstrating that we are insightful professionals that look at our own practice. In my experience of sitting on performance panels it was commonly a lack of reflection that went against the doctor in question and I never came across learning being used against a professional in this way. However legal cases are different to performance procedures. My feeling is that we should certainly continue to reflect and document learning but be mindful whilst doing so. I don't think we have heard the end of this story and we will watch this space.
* LMC stands for Local Medical Committee. These are statutory organisations that represents GPs and their practices
I have been free and easy with the term Reflection in this blog when really I am using it as a generic term for documented learning.
Dr Duncan Walling