Anchoring: when something catches your attention
During any consultation we make active choices on what we notice and when we choose to intervene. It can feel secure to focus on something we notice, such as her sleep as a means of 'fixing' the issue. Here the Anchor of sleep drops and the Doctor pursues his own agenda about this being a means for management, leading on to a discussion about Alcohol. All quite reasonable therapeutic choices, yet both the sleep issue and alcohol are consequences of the underlying issue.
If you haven't seen the other choices yet, go back and see what the GP has missed through responding to Anchoring bias here!
Anchoring bias is an important concept to be aware of- it's the first bit of information that can lead you off on an unhelpful tangent, and bias your further questions and discussion. What other cognitive biases have you explored?
SCA Feedback Statements
Relevant psychological or social information insufficiently recognised or responded to
Examiners felt that you needed to explore the patient’s social or psychological situation further, to establish context. Or that this contextual information was not sufficiently conveyed in your discussion or decision-making. Often patients present with a physical problem, but its effect may be provoked, magnified or complicated by their social or psychological situation.
This is about seeing and valuing the whole person, rather than simply their symptom. Recognising that no two patients’ experience of an illness are the same.
For example, a diagnosis of “tennis elbow / lateral epicondylitis” might appear to be relatively straightforward. However, if the patient is self-employed, currently out of work with a newly pregnant partner, suggesting a Fit Note or time away from the factors exacerbating the elbow pain might be unhelpful. A different approach to a cough or rash will be needed for someone about to take a flight to start a gap year abroad, from someone who is street homeless or someone who is a current star of musical theatre. Without establishing the psycho-social context, it is harder to produce a management plan that is appropriate and acceptable to the individual patient.
Suggestions
Be curious about your patients and their experiences. Establish the impact of an illness on their lives. Recognise and value their needs and priorities. This is not a tick box exercise, but a demonstration of wishing to understand how to make this consultation relevant, responsive and unique for the individual concerned.
Ask for feedback from your supervisor on this aspect of your consulting; role play cases you have encountered with your peers, with you ‘role reversing’ by playing the part of the patient.
Practice being curious about the person, their social or psychological situation and how this might affect their experience of symptoms, or their preferences for management/next steps.
Communication skills, including the non-verbal, respondng to cues and or active listening were insufficiently demonstrated
The examiner felt you did not demonstrate sufficient communication skills for independent practice. This may include responding to cues that could have enhanced your understanding. They may have felt your listening skills were poor, for example you may have asked questions, but not listened to or responded to the answers. Or that your consulting was ‘formulaic’, meaning it felt rigid or even scripted: Perhaps you used phrases that did not seem relevant or helpful to the person, or did not appear to acknowledge their reply appropriately.
For example, if you repeat a stock phrase such as ‘I am sorry to hear that’ too frequently it loses its impact. Perhaps when a patient says ‘I am not sociable these days’ you should have been curious as to what that means, or why. Perhaps when a patient tells you they are worried about a breast lump there is a better response than ‘OK, is there anything else you’d like to discuss today?’
Suggestions
Active listening includes paying attention and responding appropriately. It is essential for building a relationship of trust with the patient. It is helped by clarifying and summarising what has been shared to demonstrate understanding.
Cues can include non-verbal gestures, pauses in speech or facial expressions. Cues are moments in the patient’s account that indicate there are additional areas to explore.
To avoid ‘formulaic’ consulting, try to avoid rigidly applying a set consulting ‘model’ to the consultation that does not respond to the individual patient.
Watch videos of your consultations, seeking feedback from your supervisor. Notice how you demonstrate you are listening, how you facilitate the consultation and the timing of your interruptions.
Practice different phrases to respond authentically to the patient’s contribution. Watch your colleagues consult and write down every possible cue you notice.