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Barriers to expert generalist practice

Describing some of the barriers research has found we face when trying to practice as expert generalists.
Many doctors reading this will think feel that they face significant challenges when trying to practice as an expert generalist. Research into individualised prescribing has described some of the barriers GPs find when trying to provide person centred care. These were Permission Am I allowed to practice person centred medicine even if it means going against a national guideline? What if I miss an important diagnosis? Prioritisation I’m too busy to do this. I have too many other demands upon my time. Professional skills and confidence My training didn’t cover the skills I need to be an expert generalist. Performance management How do I know if I’ve done the right thing? What feedback will I get from this.
RCGP OCC ASIONALPAP ER888 What other barriers do we face when we try to practice knowledge work? Further research has described how the system we are working in upsets the (knowledge) work we do. One recent study looking at the GPs working day found clinicians were often multi-tasking and were frequently interrupted. Yet we know from established theory of cognitive load that decision making and complex task management is significantly impaired when we try to complete too many tasks at once or are frequently interrupted. This is echoed in patient safety research which highlights how system level factors lead to medical errors. As expert generalist’s we need to think about the systems where we work and whether they allow for expert practice.
Are tasks appropriately delegated? Are clinicians allowed to consult uninterrupted? Is continuity of care encouraged? Is there space for regular discussion about processes and difficult cases? Not everyone has control over their work environment and creating responsive and helpful systems is a challenging task that will take a long time. However if we aim to practice as expert generalists, we should aspire to an environment that promotes and enables the highly skilled work that we do. In our next article I’m going to introduce some case studies we will return to through the course to illustrate some of the concepts we discuss.

In this video Johanna Reilly describes research highlighting barriers faced by GPs when they attempted to practice as expert generalists.

There are also some additional resources in this step you can download to explore thus subject further.

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WISDOM - Tomorrow’s Doctor, Today: Supporting Today’s Expert Generalist GP

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