Differences, or perceived differences, in clinician workload provide fertile ground for disputes. The beginnings are always subtle and often go un-noticed.
Different clinicians will have individual work styles, for example:
A practice’s population is likely to have patients needing the full range of medical services and clinician approaches. Does your practice recognise the strengths and different approach of each clinician? Is there a consensus in your practice about where your boundary is set for demands from both patients and the NHS (ICB/Commissioners)? Do your timetabling and other workload arrangements allow good matching of demand (patient needs/wants) and supply (clinician styles and abilities)?
Consider using the Dr Chalk vs Dr Cheese assessment below (Download as pdf file):
Where are you on the Chalk-Cheese spectrum? For each pair of statements, simply tick next to the statement which most closely describes you as a GP.
| Dr Chalk | Dr Cheese | |
| Medicine is more a science than an art
Regards patients as clinical problems Respected for being well organised and skilful use of evidence |
Medicine is more an art than a science
Regards patients as needy people Respected for being interested and skilful listening |
|
| Thinks clinicians should not address patients’ non-clinical needs
Does not run late Generally seems on top of the task |
Thinks clinicians should help with anything affecting patients’ health
Often runs late Often seems overloaded |
|
| Scores low on burnout scales
Does not experience work as stressful Complaints taken as part of the job |
May score high on burnout scales
Experiences work as stressful Complaints taken personally |
|
| Minimally engaged with peer appraisal
Comfortable with medical hierarchies Does not dwell on matters that seem insoluble |
Welcomes and values peer appraisal
Uncomfortable when dealing with colleagues Takes on problems others see as insoluble |
|
| Happy to run General Practice as a business
Strives for high earnings Finds lectures ideal for CPD |
Happy to leave running the business to others
Indifferent to high earnings Enjoys group-based education |
|
| Seen as intolerant by some | Seen as a soft touch by some | |
| Sought out by patients who value clarity | Sought out by patients who value support | |
| TOTAL CHALK = | TOTAL CHEESE = |
Add the number of ticks in each column. Was your score greater in the Dr Chalk column? Or the Dr Cheese column?
Adapted from an original idea by Dr Harry Yoxall.
A practice staffed by Dr Chalks will have a proportion of patients whose needs are not met; they may leave and join the surgery down the road and the practice might become uneconomic. But one staffed by Dr Cheeses will eventually have no GPs at all, due to burnout and lack of self-care by the Doctors.
You may not find any quick answers but once again, the debate will forearm you.
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