Family Reunion

Laura and I just got back from a long weekend drive to Sheringa in South Australia.  The event was Lynette's 21st birthday celebration, and we have missed so many family events recently that we were determined to get to this one.
Laura has her learner's licence now, so she drove part of the way which was a great help to me.  I have been the sole driver in the family for the past 5 years since Anita gave up her licence due to MS.  Since every trip is over 1000km or more, it is a relief to once again be able to share the driving.  Laura ended up driving about 1200km out of the 3500km we drove for the weekend.  She gained experience in long distance driving, dirt roads, wet roads, night driving, driving in the rain, and driving in built-up areas.
Once we arrived at "Springvilla" and got a good night's sleep on the Friday night, we went fishing early Saturday morning.  It wasn't the best fishing trip we've had but a nice bag of rock cod, sweep, tommies, mullet, and salmon trout made for a very welcome lunch of fresh fish.  Much tastier than the frozen fish on offer in Tennant Creek!!
Then it was time for the main event.  All of my siblings were there: Sharon, Miriam, Samuel, Michelle, Rachel, Joshua, and Saul, along with their partners and most of their children.  Half-brother Leslie was absent, but not missed as I have had no contact with him for years.  Mum was there as well, so that made it a full family reunion, something that has not occurred for several years.  Everyone is looking older, which is probably not surprising as everyone is older.  It hardly seems credible that it is 21 years since I first began visiting Samuel and Sonya at Springvilla, when Lynette was a newborn baby.  But here she was celebrating her 21st birthday.  Several other nieces are now married, and Miriam is a grandmother.  Other nieces are at university.  The family is growing up, and the next generation is heading out into the world to make their mark.  It is great to see, as I am the first in either side of my family and the only one of my generation to have a Bachelor degree, and now the next generation has several students at uinversity and several more heading that way.
After the party, we rolled out our swags at the venue and stayed the night.  Laura and I turned in a little earlier than most because we had 1800km to drive home starting the next morning.
Was it worth driving 3500km just to spend a weekend with family?  Absolutely!  Laura had some time off work, and I was able to arrange some leave.  A bit of overtime work paid for the diesel, so off we went.  Anita wasn't up to such a long drive so she stayed home with Claire and Erin.  It would have been nice to include them in the family reunion, but the logistics were too difficult.  An advantage of having an almost empty vehicle was that we could pick up Anita's father Roger to go back to Tennant Creek with us for a month's visit.  If we had all gone to the party, that would not have been possible.

Cookbook clinical practice

For many years I have been dismissive of the trend towards what I call "cookbook practice".  This is clinical practice in which all the decisions are pre-set, and the clinician just fills in the blanks and follows the resulting algorithm for treatment or referral.  My objection was based on the idea that clinical judgement is an expected skill/attribute exhibited by practitioners, and they should not have to be spoon-fed.

Recently, I have begun to have my thinking modified by some new data (well, 'new' to me anyway!).  Safety and quality in healthcare has been expensively studied over the years, and it has been found that having clinical guidelines in place significantly reduces the incidence of adverse events.  This may suggest that even good practitioners can benefit from having robust well-founded clinical guidelines to help with decision-making.  I'm still not completely comfortable with the idea, as I worry that guideline-based practice actually reduces the need for clinical judgement.  Maybe clinical guidelines work because practitioners need help making good decisions?  What if we looked at improving their decision-making, and their critical thinking?  Would that not achieve the same or better results?

In some ways, it seems analogous to the issue of young drivers on the roads.  This group are horribly over-represented in road crash statistics, so it seems logical that something needs to be done.  Is it more training and guidance for a longer period of time that is required, or is it more effort into creating drivers who think actively about what they are doing and learn good attitudes and habits?  If having L-plates for 2 years proves to be safer, what about 3 years?  If the restrictions of provisional drivers licences make young drivers safer, what's wrong with applying those restrictions to all drivers.  After all, if we did not allow anyone to drive until they were 21, the road crash data for 16-20 year olds would improve dramatically!

I think the answer is the have reasonable guidelines, then teach people how to think properly.  Some sort of attitude test if you like.  If you don't pass, you don't get a licence until you grow up a bit more.  I know some 16 year olds who are more mature than some 46 year olds, and much safer drivers as a result.  Likewise with clinical practice, I think it should be mandatory to pass some sort of critical thinking test before you are allowed near patients.  How that would look in practice, I'm still thinking about.  Watch this space ...