RCPCH Progress - domain of the month: Patient management

Patient management is important for paediatricians be that with children and young people, parents and carers, other care professionals or colleagues. This is one of a series of resources - developed with and by trainees, supervisors and children and young people - to support trainees in understanding and achieving this curriculum domain
Last modified
5 April 2019

What do children and young people say?

We asked what patient management with services means - here's some of what they said:

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Overview and teaching resource

Our presentation explains the patient management domain in more detail, and can be used as an overview or for a teaching session.

Download presentation (PowerPoint)

Video - Views from a consultant

[Patients and parents] will tell you the symptoms and the diagnosis in their own way, and it's for you as a doctor to interpret that.

Dr Peter Dale, RCPCH Officer for Training and consultant paediatrician at Royal Gwent Hospital, emphasises the importance of listening to your patients and their families, remembering the common diagnoses and working with your whole team.

Next, our case studies give examples of evidence that could be used to demonstrate contribution towards the domain learning outcome.

Case study 1 - Sharing evidence-based practice

Looking up evidence develops your clinical skills in managing the specific condition

Setting: Paediatric on-call rota

How did the opportunity arise?

During morning handover there was discussion about the management of a patient from overnight. 

What happened?

During a night shift in the Emergency Department you see a three-year old child with a barking cough, stridor at rest and respiratory distress. You diagnose them with croup and give dexamethasone. Despite this, two hours later they still have some respiratory distress, so the decision is made to keep them overnight. In morning handover there is a discussion about the dose of dexamethasone and whether the admission may have been prevented with a different dose. 

You have not heard of higher doses being used. So you decide to look up local and national guidance on the management of croup and do a literature search.

How did this support your development?

Looking up local and national guidance and recent research is the foundation of evidence-based practice - a key capability at all levels of paediatric training.

Looking up evidence when such situations arise develops your clinical skills in managing the specific condition concerned. It also develops your ability to search for and interpret evidence for future cases.

Any practical tips?

It is not uncommon for management of patients to be discussed during handover. It is often the first time a patient is discussed with a consultant. Occasionally such situations can feel confrontational. Using the technique of suggesting that you do an evidence review can provide a valuable learning opportunity. 

To extend this learning opportunity you could present the findings of your evidence review during a 10-minute teaching session. This will develop your presentation and teaching skills and allow you to model evidence-based practice for more junior colleagues. 

Case study 2 - Encouraging young people to participate in their care

You reassure the young person you will not be angry with them in clinic for having high blood glucose levels... together you agree a plan.

Setting: Paediatric Outpatient Clinic

How did the opportunity arise?

Leading a consultation in a Paediatric Diabetes Clinic with an adolescent with Type 1 diabetes.

What happened?

You note before the patient comes into the clinic room that they have poor metabolic control, with a high HbA1c. Looking at a download of the blood glucose monitor it is clear they check their blood glucose infrequently. You make a plan of addressing these issues with the young person. 

When the young person enters the clinic room they make very poor eye contact, and appear very anxious about the clinic. You recognise that directly challenging their current engagement with treatment may make things worse. Therefore, you user other communication techniques, such as motivational interviewing to try to engage the young person.

Eventually you manage to engage the young person in a conversation about blood glucose testing. They admit they do not like testing in public at all, and they have gone off testing at home because the numbers are always high.

You discuss that although the numbers may be high now that is okay. And, that testing will allow you to work on bringing the numbers down together. You reassure the young person you will not be angry with them in clinic for having high blood glucose levels. Together you agree a plan to start testing twice per day. You acknowledge that this is not best practice, but is a good stepping stone for that patient.

You also arrange follow up with the psychologist to work on managing diabetes in public. You agree they will come back to clinic in two months.

How did this support your development?

Acknowledging that the standard treatment plan may not be the best option for all patients. Being able to work with patients to decide on realistic individual goals, which will improve compliance with the treatment plan agreed. 

Knowing that the doctor may not always be the best person in a team to address all issues, and so making the most of all members of the multidisciplinary team. 

Any practical tips?

In young people with a whole range of chronic conditions, the majority of care occurs outside the health care environment. It is therefore very important to ensure that patients understand and are motivated to engage with any treatment plan they are started on. There are lots of different consultation strategies that can be used to try and improve this, such as CBT (cognitive behavioural therapy) or motivational interviewing.

To further this educational experience it would be beneficial to try to see this patient next time they are in clinic, to see whether they did manage to perform the agreed plan and to continue building that relationship.

Case study 3 - Understanding multi-professional management

Try to ensure you meet as many members of the MDT early in your rotation

Setting: General Paediatric Ward

How did the opportunity arise?

During post take ward round, reviewing a four-year old with recurrent respiratory admissions.

What happened?

A four-year old boy has been admitted over night with an acute episode of wheeze. This is his fourth admission over the winter period. Last admission he was started on a steroid inhaler, but his mum has not been giving him this due to concerns over his growth. It is also noted by the nurses on admission that the family had not brought his steroid inhaler nor the spacer with them, just a salbutamol inhaler.

After discussion on the ward round it becomes clear that the family need much more education than can be provided in a short ward round consultation. Therefore, you arrange for the respiratory nurse specialist to come and see the patient and family whilst they are an inpatient.

How did this support your development?

Recognising the key roles different members of the MDT play in the management of acute and chronic conditions to get the best outcomes for your patient. 

Any practical tips?

When you rotate through different hospitals try to ensure you meet as many members of the MDT early in your rotation and discuss with each person their role. Different hospitals utilise their MDT in different ways and you do not want to miss out on a valuable resource because you did not know they were available. 


Special thanks and acknowledgement to Claire Mathews and to all those who contributed in providing the content for this patient management domain.