Clinical case discussion: using a reflecting team
At first, using a reflecting team can seem a little artificial or inflexible. Yet case presenters nearly always report afterwards what a relief it is to speak without interruption, to have an opportunity to clarify the case, and to listen to a range of different perspectives, without having to give an immediate response. Team members find they can use questions to raise a whole range of different aspects of the problem, including the technical details as well as the psychological dimensions of the case or its impact on the presenter. If they wish, they can also discuss the wider organisational or resource issues affecting the case. Letting presenters listen to everyone else in silence gives them time to digest any ideas properly, and to take ownership of whatever decision they make as a result. It is relatively easy for someone to facilitate the whole conversation, make sure that everyone follows the rules, and invite each person present to ask at least one question and expresses a view. The rules are adaptable according to circumstances: for example, in a training context, juniors can be invited ask questions and offer their opinion before their seniors do. The method can also be used for discussing non-clinical issues, including difficulties in the workplace. As well as producing benefits in individual cases, regular use of the approach can instil a more reflective and collaborative approach to medicine. Participants in reflecting teams soon discover there is rarely a single way of looking at any clinical case, nor any single correct way of managing it. They can become more at ease with clinical uncertainty, more respectful of their colleagues’ opinions, more comfortable about having their own ideas subordinated to the combined expertise of the team, and more compassionate towards complex or challenging patients.10 There are few more salutary experiences in medicine than discovering that the collective mind of a reflecting team is more powerful than your own mind can ever be on its own.