Hana Esack is an ST2 GP registrar in South Worcestershire, developing an interest in Medical Education and Lifestyle medicine.
As a GP trainee, I have reflected on the challenges surrounding the process of gaining senior support during clinical consultations. The ability to access trainers varies considerably between practices, depending on the systems implemented to support accessibility. When this access relies on the traditional ‘door knocking,’ the approach is often fraught with logistical barriers and embedded power dynamics.
The act of “door knocking” i.e interrupting a colleague who is themselves consulting – can feel burdensome.
In clinical scenarios that are unfamiliar or require in-person review, trainees are often forced to leave their patients mid-consultation to seek help. The act of “door knocking” i.e interrupting a colleague who is themselves consulting – can feel burdensome. This hesitation is compounded by the silent power imbalance inherent in asking for assistance, particularly when the response is unwelcoming or dismissive. Although seeking supervision is expected and often encouraged during training, encountering resistance can significantly undermine a trainee’s confidence. It also creates a dilemma: return to the patient without a second opinion, ask them to wait while assistance is sought, or attempt to find a more approachable colleague willing to help. This situation then may inadvertently result in friendlier GPs becoming overburdened by frequent requests, while encouraging others to adopt a more distant or “gruff” persona to avoid interruptions.
Various alternatives can be trialled to address these challenges. Instant messaging platforms may facilitate real-time communication, but responsiveness is not guaranteed. The introduction of dedicated slots during which a GP is available for queries can be useful but is less effective when a patient requires immediate in-person input. These windows are also vulnerable to being cut short by clinic overruns or clashing responsibilities such as home visiting.
These issues can become became particularly evident during extended tasks not previously undertaken in a general practice, for example where a trainee is asked to perform an antenatal check or a six-week baby check. Without a designated trainer available for direct supervision (If attempts to find a colleague with sufficient availability are unsuccessful) a check may ultimately be performed alone. Even if a trainee has previous experience in obstetrics or paediatrics, this would might been an inappropriate scenario for someone without some background experience. Given that (for example) six-week checks may represent the infant’s last face-to-face medical contact for months, an incomplete check risks missing serious findings with potentially life-altering consequences.
…many of these challenges stem from time pressures inherent to general practice and trainers may simply not have the capacity to offer consistent real-time support.
The cumulative effect of these barriers to accessing supervision can negatively impact both trainee development and patient safety. Confidence may be eroded, and trainees may be forced to make clinical decisions based solely on limited experience or guidelines. If this is later deemed incorrect, it may require callbacks and reversal of plans which may affect not only patient outcomes but can undermine the trust within the doctor-patient relationship.
In my own experience, one potential solution is to have the GP responsible for a non-patient-facing role act (such as triaging) as the trainee’s point of contact during that session. It is however recognised that this model is not universally feasible, and triage GPs are often under significant pressure themselves.
It must also be acknowledged that many of these challenges stem from time pressures inherent to general practice and trainers may simply not have the capacity to offer consistent real-time support. In this context, trainees may need to recalibrate their expectations and develop skills by triaging their own support needs. Promoting “triage thinking” by assessing the clinical urgency of a question before escalating may allow trainees to decide whether an issue can be addressed during scheduled tutorials or requires immediate input. Additionally, being transparent with patients- for example, by openly stating that advice will be sought and the patient will be contacted later- can help build trust and reinforce honesty within the doctor–patient relationship. Importantly, sitting with clinical uncertainty is uncomfortable but, at times, necessary- especially when framed by patient safety considerations.
Featured photo by Annie Spratt on Unsplash.
