Medical training versus solution focused therapy training


They are both patient-centred (or should be!), they are both rigorous in terms of the effort required. Why then are the learning and practising environments so different?

First up, I love medicine. Not a little, but hugely! If I had my time again, I’d hope to make exactly the same leaps and little stumbles that brought me here to my niche in Paediatrics. I can’t imagine a more fun, satisfying or rewarding career (except one that has Solution Focus Therapy embedded in it’s fabric!).

Medicine attracts those with minds demonstrating an ability to absorb and regurgitate complex scientific material – they encompass all personalities with this. Solution-focused therapy also appears to encompass many & varied personalities, but they appear to share more personality traits.They can focus on positives in a sea of negatives, they can probe and probe sensitively to push doors gently open. They can put their egos aside and happily become invisible within the consultation.

Medical training is to an extent very didactic and very competitive (I mean that very sincerely in a positive way). Doctors learn to weigh possibilities and probabilities and arrive at a diagnosis. It’s always a risk – just the most likely based on the information available at that point. The public haven’t as a rule appreciated this however. Don’t get me wrong – taking any risks is wrong. It is merely the inherent risk in the actual cause being something very rare or an unusual presentation, or that the essential diagnostic information has not yet declared itself rather than any form of incompetent or negligent decision.

As a recent US doc commented ‘docs can do “grey”‘where nursing training is more protocol or “black&white”. One drawback to this is that doctors virtually always have AN answer and they have to pursue it with a degree of convincing confidence. As with any risks – sometimes they’re wrong.
As a group we also seem to have a guilt complex – we beat ourselves up even when we couldn’t POSSIBLY have altered the outcome. Admitting failure is seen a weakness. But surely occasional failure is inevitable? -it’s reducing the frequency and magnitude that are real skills.

I’ve always been open to criticism of my decisions. It’s healthy not just for humility but offers real protection against the risk of making an error. It’s also healthy for junior staff to be able to critically reflect on senior’s decisions. Nursing staff in particular are very good at expressing their reservations about diagnoses or treatment decisions. This makes for a supportive and dynamic environment. It also gives me much greater confidence knowing that my team are part of decision-making and will not hold back on making their views known – even if they are widely different to mine.I’m frankly not interested in a ‘yes’ team.

Sir Lancelot Spratt is long- dead here!

Perhaps this attitude meant I was ‘ripe’ for SFT training!

How was it different? How,if at all, was it similar?

Starting with a positive mood-setter was eye-opening (and certainly mind-opening!) for me. It was an integral part of the day, of the group dynamic. There was some didactic teaching, but inevitably followed by lively discussion and questions!

People made suggestions and criticisms were not really criticisms but merely observations. The material was often very personal giving participants a stake in it. The positive feedback was exactly that – it made people feel ‘up’. Participants wanted to keep in touch after the course and shared previous experiences and hopes for the future.

Conferences in medicine can be like that. Resuscitation courses are often the opposite. They feel competitive. They have scenarios (just like role-play here) but where positive feedback is given first it tends to be slightly perfunctory and just act a sweetener before the real business of getting down to criticising. There is an attitude of ‘all in it together’ or ‘there but for the grace of God’ evident though.

Submitting work is different too. I spent ages thinking through my certificate essay and rejigging it in my head. After I eventually wrote it (a thoroughly enjoyable process) I submitted it (as a first draft). I expected negative criticism and a few rewrites and resubmissions. Chris Iveson had already made it clear that it was the authenticity of the story and the material that really counted. I didn’t really believe him – & I was wrong. 100% wrong!

The feedback was very positive and the essay has been modified slightly and submitted in Solution News in March 2012. I was on cloud 9!

I’m hoping to enrol for the Diploma in September and am eager to do it – not like many medical courses where you want to have done it rather than actually enjoy the doing it.


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