1:00:00 HOUR

Episode 31: STC International with Genevieve Yates

August 09, 2017

One comment

  1. Dear Art and Nic,

    Thank you so much for using my case for Stump the Chumps. You did a great job and shared some really important educational gems.

    I chose the case because it illustrates some of the clinical reasoning and management challenges when assessing and managing some of the more complex primary care patients. (Spoiler alert – there isn’t a glorious diagnostic prize revealed or a great “ah ha” moment”).

    Welcome to swamp gardening, Australian general practice style. I was introduced to the concept of swamp gardening by GP, researcher and medical educator extraordinaire, Dr Louise Stone, and I have to admit I’m quite taken with the metaphor.

    It relates to the messiness of general practice: the reality that we spend much of our time dealing with undefined and sometimes undefinable illness. We are taught to approach a presenting complaint in a stepwise fashion: history, physical examination, investigations, diagnosis and then finally management. In primary care, although this process and the clinical reasoning which informs it, is still vitally important, the “answers” are not always clear cut. Patients are complicated, consultation times are short, disease processes don’t read the textbooks.

    Donald Schön, in his book ‘Educating the Reflective Practitioner’, wrote: “In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the application of research-based theory and technique. In the swampy lowland, messy, confusing problems defy technical solution.”

    No one would deny that swamp gardening can be frustrating and draining. However, if you are searching for meaningful, important and interesting work, you’ll find it in the swamp.

    It is challenging to sail the diagnostic sea without sinking under the weight of over-investigation or being capsized by a missed serious condition. It takes intellect and bravery to negotiate the treatment maze without a map. And there’s immense reward and satisfaction to be gained by wading through the swamp with your patients, weeding and planting. Efforts which, if you’re lucky, will occasionally bear fruit.

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