Supporting your community of practice

Let’s return to a previous case study to see how we might use these ideas to put our scholarship skills into practice. We will use the example of Margaret to help us think about how we share the learning from our experiences.

We met Margaret in week 1 when she presented with chronic back pain and fatigue. When she returned she had some questions for you about her B12. She has a background of Pernicious Anaemia and is on 3 monthly B12 injections. During the consultation, she mentioned that she was feeling tired all the time which she felt was due to not getting her B12 injections frequently enough. Her recent B12 levels were normal, but she mentioned that she had read in a magazine that the B12 assay can be inaccurate. In week 2 we discussed how you might search for further evidence to understand whether more frequent B12 injections could improve Margaret’s symptoms. We also discussed how guidelines can often omit some of the valuable evidence from social sciences literature that can sometimes help us explain these more complex challenges.

Would you prescribe Margaret’s B12 injections every 2 months instead? Comment in the discussion below to see what everyone thinks!

Reflecting on this case again, do you feel it right to turn down Margret’s request for more frequent B12 injections? It is very normal for a patient with a chronic condition to do their own reading about it online. Would you prescribe her B12 more frequently despite this being against the guidelines?

There is no correct answer here. The guidelines do not guide us on how to manage this situation.

How do your colleagues manage similar requests? Have you ever had a conversation over a coffee within your team about a case like this? What did you do as a result? How did you act on that conversation and use it to support your community of practice? As discussed in week 1, this is how John Gabbay described how GPs do this every day knowledge work in coffee room chats, every day, as part of our creation of mindlines.

Having conversations such as the one in the picture you are creating and developing mindlines – in doing so you are discovering new knowledge and may have already integrated the new knowledge into your practice.