You need to complete a 1500 word ‘clinical log’ in order to meet the 3 learning outcomes:

LO 1- Perform or request relevant diagnostic and therapeutic procedures to facilitate effective management of the patient.

LO 4- Work within a multidisciplinary team to deliver medical care pathways for patients demonstrating professional behaviour and probity.

LO 5- Promote patient education, counselling and health promotion through management plans with patients and carers in agreement with other healthcare professionals.


You need to select 3 and write 3 x 500-word critical reviews, using the individual learning outcome to focus your writing ie. one 500-word critical review per learning outcome. This will make up the ‘clinical log’.

You can meet each of the Learning Outcomes in whichever of the three cases you select but you must select a new case for each of the learning outcomes. Below are some examples the team has thought of to help you get an understanding of what is required. 

For example, you might have encountered a paediatric case where there was a need to perform a diagnostic or therapeutic procedure as part of the child’s management plan. The critical review in relation to LO1 could focus on the relevance of the procedure; was it the most appropriate procedure; was the child sufficiently cooperative or was the procedure compromised during the process? Alternatively, the critical review might be about the use of therapeutics/distraction to have managed the issue with greater success. Another option would be to explore the sensitivity and specificity of an individual test and how this might change with pre-investigation probability estimation.

In your mental health clinical placement there will be many encounters which would enable you to critically review professional behaviour and probity within the multidisciplinary team in delivering the medical care pathways for patients, ie. LO4. 

Alternatively, with surgical speciality in mind, there could be an exploration of early discharge planning teams for elective surgical cases; or pre-operative assessment teams.

Finally, thinking of LO5, a classic example would be a critical review of a pregnant lady needing to stop smoking or reduce/ stop her alcohol intake. Other potential sources are obesity in relation to bariatric surgery or the risks/benefits of surgery in an obese patient. The promotion of safe sex with regards to the Sexual Health would also be an appropriate option.

Learning Outcome One: Case Description

A child, 6-year-old child, is suspected to have fallen while playing at school and presented with the weakening of the right lower limb to the Accidents and Emergency department of the hospital. The child was previously well until the day of the fall. The weakness was insidious in onset after the fall and the child also complained of pain in the lower limb. The pain was localised around the right hip joint. The pain was severe and scores 5/6 on Wong-Baker paediatric pain assessment scale (Wong Baker, 2017). The pain was exacerbated while she was walking or standing upright. The parents reported that the pain is relieved by taking painkillers and has been consistent since the fall. Lying prone on the bed also relieves the pain. There is no other significant complaint in the child. The patient has not been operated on before. The child achieved all developmental milestones at the right time and age. There was no associated fever.

Learning Outcome Four: Case Description

Want this one made up for a severely suicidal depressed patient. A psychiatric ward and how in the MDT does a psychiatrist or psychologist and doctor and pharmacist work together? 

Learning Outcome Five: Case Description

A female patient aged 34 years arrived at the General Practice with complaints of cold, shivering even in in hot weather. The patient also has complained of muscle cramps for more than six months now. Despite the loss of appetite, the patient has gained considerable weight in the last six months, and any attempts to lose weight have failed. In addition to the above complaints, the patient claims to be having coarse hair that easily plucks off. There is a positive family history of the above symptoms, and the patient has been smoking for the last ten years.

To look at diagnostic investigations and write at level 7 to ways the pros and cons. If with the guidelines or against the guidelines and why?

The case

Points of analysis

Xray of hip – what are the guidelines in a limping child?

Look at published guidelines NICE on limping child x-ray. Are there any variances in what was done? Why was this investigation done? Interpret these issues. Can you identify the evidence based literature backing up a statement? What did nice base that on? Range of reasons like no we do ultrasound or something else etc. There will be a rationale for it. Then you contrast with what happened. Some rational may not be rational.  Was it because they were following told guidelines, pressure from parents, general MOT of all patients? – That’s is their protocol, their default mode, analytic part where they doing any harm in doing an xray?,  or why do nice advocate you don’t do a xray? Concentrate just on x rays, leave other investigations out because you only have 500 words for each case. Scoring points here is why did they make the decision to do an xray? They did look at other inflammatory markers, CRP in this case WAS RAISED, which would fit in with guidelines of nice? Inflammatory tissue problem septic arthritis.  Looking for effusion in actual joint? Can say a number of investigations were done which met national guidelines however concentrate mainly on x ray.

 

2nd one how do teams work? A group of people and describe what  2 or more of what the people do which is different from one another and what they bring to the party. A team has to come together to make the best battle plan. E.g. a person who is having thyroid surgery, so seen by a speech therapist, ENT surgeon to make sure air way is fine, possibly by an endocrinologist to advise when patients thyroid is removed you needs to maintain things etc. So they come together and and make a battle plan. Another e.g. lower back pain where they have been seen by a physiotherapist, seen by surgeons, being placed on ICU – there will be rehabilitation issues etc  whats battle plan and how they work together. Commonality a number of people who are not all doctors or nurses and come from a variety of disciplines and have something to offer bring together for the benefit of the patient. Case has to be on something which I have experienced and seen this team work together . Doesn’t  have to be perfect like the team wasn’t talking to one another, people were not at a meeting and a number of things had to be repeated,  people began going on tangents, need some guidelines in supporting what they say and if they didn’t why not? Psychiatry is easy one, why do you need a psychiatrist and a psychologist both come from a slightly different background, having a pharmacologist in there too, find literature to support that. What guidelines say that this particular format of a multidisciplinary works or not. Team has to have a focus.   A patient with a particular difficulty and the teams comes together as a focus to be able to demonstrate their different attributes or not. Nurses, doctors, social services, patient advocate, pharmacist,. Find potential conflict, who was in the team, how was it explored, what are the pros and cons of the psychiatric team work.  For this case I wanted to use a psychiatrist or psychologist and pharmacist or doctor and how they benefit a severely depressed patient and how they work together, what benefits do they bring and do they work according to published literature and why and if they didn’t why not.

 

3rd How was the information given to the patient? How did the patient react to the information? Difficulty is trying to produce behavioural change. Patient’s knowledge of thyroid was a problem, which I had to explain, then there was her addiction, does this person change their behaviour? I felt at the end of the consultation of changing behaviour was 0.  So what was said, how the patient reacted, why was it said, knowledge level non existent. – So suddenly at disadvantage anyway, how the patient perceived it , what did she say and how I responded back to her doubts, however not a successful outcome. Literature out there to say do patients listen or change their behaviour , what would have been done then, does it say we have to bring her back, or write in notes if she comes back it needs to be mentioned again, repetition, peoples receptivity changes. If then she came with a chest infection she would know it’s partly due to smoking and would want to change her behaviour.  So trying to produce a behavioural change. Analytic part – looking at published literature and difficulty in people changing their smoking habit or behaviour, and also another aspect is those with poor knowledge about their condition.

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