Yonder: thank you Ahmed Rashid, email consultations, ethics rounds, and medical elective fees

Alex Burrell is an ST4 Academic Clinical Fellow in General Practice based in Bristol

 

In March Professor Ahmed Rashid said farewell¹ to Yonder, the column he founded in 2014² to shine a light on ‘hidden gems’; primary care research papers published in journals outside the medical mainstream which could broaden our horizons and the way we think about medicine. Throughout my vocational training, Yonder has reminded me to remain curious and open to areas beyond my own interests, to take the blinkers off and look around. Looking back through ten years of columns with 120 consecutive issues and almost 500 papers discussed, a vast range of clinical, social, and ethical issues have been included. Occasionally alliterative (‘PTSD, piles, Pharma visits, and parkrun’ stands out from March 2018³) and always intriguing, there has been something for everyone in the titles alone. I am grateful to have been invited to take up the mantle and will do my utmost to preserve the spirit of this BJGP institution as we thank Ahmed for the last decade.

Email consultations

Remote and/or asynchronous consultations now make up a significant proportion of GP workload, and in theory are designed at least in part to save clinicians’ time. I haven’t come across much email consulting in the UK, but this Danish study⁵ explored patient – specifically older adults – and GP experiences of email consulting. Patients felt they were saving time by avoiding telephone or physical waiting spaces and appreciated the opportunity to hone their thoughts over multiple drafts of an email consultation. Interestingly, patients felt they were saving GPs time by not taking up an appointment, but GPs had a very different view regarding these consultations as ‘overtime work’ with a never-ending inbox that they often had to continue reviewing at home. This feels very familiar – any asynchronous consulting tool needs a lot of thought about recognising and remunerating workload and establishing boundaries.

Ethics rounds

Plenty of us will have likely come across the eponymous Schwartz rounds and Balint groups designed to help staff process the emotional challenges of working in healthcare. In a study in Sweden,⁴ researchers qualitatively assessed ambulance staff’s experience of ethics rounds, groups designed to ‘support healthcare clinicians in coping with ethically challenging situations’. These take a familiar structure of facilitator

enabling case discussion and deliberation but are focussed on training and developing staff’s ability to critically reflect on ethical principles, in this case in cases relating to older adults. The success of these groups largely depended on the competence and skill of the facilitators, and fictional pre-recorded cases led to more reflective discussion than individual clinicians bringing a case. Participants appreciated the opportunity for development of ethical appraisal skills, though whether this could lead to improved care or a change in future reasoning remains to be seen.

Medical elective fees

Going on elective was a highlight of medical school for many, but deciding where to go can be decided by cost rather than clinical exposure or learning opportunities. Examining medical elective reports from students in German-speaking countries who went to the UK, Australia, New Zealand, Ireland, the US, or South Africa, this study⁶ found electives in the US were significantly more expensive than other countries with a median cost of €1875 for a 4-week elective, having increased dramatically from 2006-2020. Fees in South Africa and Australia were higher than the UK and Ireland. This analysis did not include other costs associated with expenses including application and administration fees, accommodation, insurance, travel etc. which are likely to have increased as well. Whilst this focuses on relatively few countries, universities and hospital trusts need to avoid pricing aspiring elective students out of invaluable experiences.

References

1. Rashid A. Yonder: Farewell. Br J Gen Pract, 2024;74(740):133.
2. Rashid A. Finance, fibromyalgia, caring, & communication. Br J Gen Pract. 2014;64(622):244. doi:10.3399/bjgp14X679778
3. Rashid A. Yonder: PTSD, piles, Pharma visits, and parkrun. Br J Gen Pract. 2018;68(668):136. doi:10.3399/bjgp18X695117
4. Frank C, Rantala A, Svensson A, et al. Ethics rounds in the ambulance service: a qualitative evaluation. BMC Med Ethics. 2024;25(1):8. Published 2024 Jan 18. doi:10.1186/s12910-024-01002-6
5. Grønning A, Simonsen LM, Lüchau EC, Hvidt EA, Klausen M. My time, your time, our time. Older patients’ and GPs’ time sensibilities around email consultations. Health Sociol Rev. Published online February 22, 2024. doi:10.1080/14461242.2024.2316742
6. Beckschulte K, Lederer AK, Storz MA. Long-term trends in international medical electives fees: a database mining study. BMC Med Educ. 2024;24(1):152. Published 2024 Feb 19. doi:10.1186/s12909-024-05123-9

Featured Photo by Aniket Bhattacharya on Unsplash