PUNS & DENS.
This consept was developed by DR Richard Eve in his book.
PATIENTS UNMET NEEDS DOCTORS EDUCATIONAL NEEDS
The process of self analysing situations where a patient may not have received the optimal advice or treatment.
To recognise a PUN in the consultation we must LISTEN. Record those PUNS in a log book. These are now called DENs.
They can be clinial knowledge ( ex HRT) , skill ( implanon removal) or attitudinal ( how to manage aggressive patients).
Good to find blindspots / unknown unknowns / unconscious incompetence.
Aim to get 1-2 per day at most.
Must then make time to rectify these gaps - ( ex - personal reading for HRT, colleague demonstration for implanon and MPS workshop re difficult patients).
Limits.
- Have to be looking for knowledge deficeits.
- Can't be perfect!
- So much TENS, so little time.
- Records too little - too confident, weary, burnt out?
- Records too much - overwhelmed, may reinforce lack of confidence.