Reflective practice, in medicine, is a thought process where doctors consider their work experiences to gain insight into their clinical practice. Writing their thoughts down is a routine part of a doctor’s work. It gives them the opportunity to deepen learning and improve the way they work and the care they give to patients.
Rajan Madhok, now retired, was an orthopaedic surgeon initially who went on to become Medical Director at NHS Manchester. Rajan has used reflection throughout his career and personal life to develop critical thinking and ‘to describe things as I saw, and felt about, them and if I got them wrong to apologise.’ Here, Rajan, who was also a GMC Council member from 2009 to 2012, advocates for more reflection as a positive tool for work and life.
Through recent conversations with younger doctors I have a sense that there is growing recognition of the importance of reflection, and an acknowledgment of its usefulness in the practice of medicine. Let me give you my short, personal story of how I have used reflection to illustrate this.
From the outset, I will point out that I have no formal qualifications when it comes to reflection. My learning has been on the job, so to speak. My reflective practice comes from my lived experiences rather than from an academic approach, and I am still learning.
My reflective journey began, unknowingly, in 1988, when I left clinical medicine and started retraining in public health where I went on to hold several senior medical management posts. It was only when I had formally retired from the NHS and was collating my various writings of 25 years that I became aware that what I had been doing the whole time was ‘reflecting’. in 2013, I published these reflective writings.
Once I saw them collated, the value reflective practice had on my life became even more apparent. My life mantra is ‘do good, have fun and make (modest) money’. I strongly believe that I have only been able to live by this mantra because of my reflective practice.
Reflection is easy if you don’t get bogged down in the technicalities. Basically, it is asking yourself:
- What am I doing?
- Why am I doing it?
- How well am I doing it?
- Can I do it better?
As you get going, the practice becomes easier and more meaningful. You will get better at making sure that your time is well spent. You will also move from reflection-on-action (the retrospective look) to the real-time reflection-in-action and start living in the moment.
Here is a challenge: Imagine yourself after 40 years of working and telling your story. Would you be satisfied and at peace? Then ask yourself: Am I now doing the things that will help me get where I want to be? Reflect before, during and after action and, as they say, ‘Bob’s your uncle!’
Life does not follow traditional educational frameworks where one learns theory and then practises to minimise mistakes. Rather one makes mistakes in life and, if insightful and alert, learns from them and improves.
In essence, reflection is about being wise. Being a reflective practitioner can prevent the pain and disappointment and makes all the difference between the average and good, and between lived and lived well.
Ask yourself if you are you on the road to wisdom and ready to do good, and be a great doctor (and partner, child, parent, friend etc).
Danish poet, Piet Hein, sums up reflection beautifully for me in his poem (grook):
The Road to Wisdom
The road to wisdom? – Well, it’s plain
and simple to express:
and err again
More information on the GMC reflective practitioner can be found here.
Details of Rajan’s reflective practice can be found here.
Rajan has also developed a learning resource called Reflection for Health Care Workers,and is presently developing a reflection journal to help doctors who have approached him to mentor them. Please contact Rajan if you have any questions, or would like to discuss reflection further: firstname.lastname@example.org.