Clinical Conversations turn magical when we speak our minds about Patients.

Introduction

Today afternoon, the senior clinicians and I had a conversation while at the practicum site. It was exciting for us to learn from each other regarding perspectives related to patient care. Every minute was valuable during the meeting due to the rarity that comes with such moments. Much of the students' time is spent in the surgical unit and therefore there is limited time for such clinical audit discussions as of now. Nonetheless, I was delighted when we met today.

What happens when we bring our minds together?

During the meeting, I learnt that the clinicians had passion to learn more about the delay for diagnosis of large bowel obstruction for a particular case due to late hospital visit by the patient. What I gathered from the conversation was that the case was multimorbid, with active peptic ulcer disease progression and lobar pneumonia whose treatment elsewhere, a few weeks ago was not clear.

Photo on the right: Benard with Samuel Wachira and Antony Gaturu before the clinical conversation session at Kiambu Level Five Hospital in October 2024.

It seemed like the patient was absolutely constipated, and had sepsis. This was a worry to consider, to say the least. Surgical evaluation and treatment had post-operatively led the patient into colostomy care in the ward. Such case that required aggressive nursing care with compassion was worthy for discussion and deliberation.

Five Star Doctors with Principles of Family Medicine on hand

As students exchanged ideas regarding management of the case, I noted that the Family Medicine (FM) themes of contextual care, patient centredness and continuity in care were being applied in the discussion. In summary, the following recommendations from the students during the discussion would make you realize what each of the themes meant.

1. That the patient required emotional and social support, more often than just treatment using drugs.

2. That each visit by the students at the practicum site would be an opportunity for them to offer support to the patient while they (the patient) undergo post operative care.

3. That it was important for the Multi-Disciplinary Team (MDT) to understand the feelings of the patient while on treatment and develop ways of handling those feelings.

4. That patient required follow up.

From Left to right: Benard Kusienya, Samuel Wachira, Antony Gaturu, Samuel Otieno, Anne Wairimu and Tiffany Kinyanjui during a clinical conversation at Kiambu Level Five Hospital in October 2024.

I enjoyed every bit of the discussion, and was happy to see students exchanging ideas, particularly on the role of surgery in the care of the patient. What was more interesting was that the surgical conversation blended with a discussion on the primary care components. From the conversation, I would relate the above four recommendations with the following McWhinney's principles of Family Medicine (McWhinney, 2009);

1. Subjective aspects of illness

2. Using each visit for preventive purposes

3. Patient centredness

4. Open ended commitment

Conclusion

The students demonstrated the values that a Family Doctor would need while in medical practice. The care giving role, decision making, communication, resource management and leadership roles (Boelen, 1996) were evident in the discussion. Looking at all aspects that emerged from the discussion, it is agreeable that such students are a generation of practitioners with a promising future that is anchored in comprehensive patient care.

Benard Chinua

References

Boelen, C. (1996). The Five star Doctor: An asset to health care reform? World Health Organization, Geneva, Switzerland.

McWhinney, I. R., and Freeman, T. (2009). Textbook of Family Medicine. Oxford, Oxford University Press.