Reflective discussion with appraiser

In this scenario:

  • a doctor first notes down their thoughts on an experience in preparation for an appraisal discussion, using the 'What, So what, Now what' framework as a template
  • the doctor has a reflective discussion with their appraiser during their appraisal based on their thoughts
  • the appraiser enters a note of the reflective discussion in the appraisal documentation.


A patient has stopped receiving Disability Living Allowance and had applied for the Personal Independence Payment (PIP). The doctor felt strongly that the PIP assessor's decision was wrong and unjust, and took action by appealing the decision. The doctor reflects on channelling their emotions and the resulting effect this had on them and others.

Read the different stages of the scenario

A doctor (Dr EE) gathers thoughts on a reflection in preparation for appraisal, using the 'What, So what, Now what' framework

Dr EE has a reflective discussion with the appraiser (Dr ER)

ER: Your reflection on your patient's PIP application was very interesting. Tell me more.

EE: It feels unjust when system changes backfire on my patients. My patient looks as if there is nothing wrong with him but he will never be able to lead an independent life because of the brain damage just after he was born. I'm still frustrated by it.

ER: (echoing) You really are frustrated - and you seemed to imply that was useful to you.

EE: Yes, when I came to reflect on it, I realised that how this incident made me feel was a powerful energiser for action. I have rarely produced a PIP appeal report as quickly or effectively. I really felt that every word came out how I wanted it to.

ER: Do you have a strategy to avoid firing off e-mails or letters in haste?

EE: I do - I always type my response up and then leave it for 24 hours to re-read it once I've had time to reflect on it. If I am unsure, I ask one of my colleagues to 'read it for tone' and sense-check what I am saying. In this case, I was even more pleased with myself when I re-read it, because it said exactly what I wanted professionally and succinctly.

ER: That sounds very satisfying (affirmation).

EE: It was. It's even more satisfying because I had a phone consultation booked in last week with this patient's mother. She wanted to let me know that the appeal has been successful and my patient has been awarded the full backdated benefit. I was thrilled for them - and pleased with myself.

ER: So what is the main thing you have learned from this?

EE: I think that feeling that something is unjust can be harnessed for good things.

ER: Now what will you do differently as a result?

EE: I've set up a PIP appeal file on my private desktop to keep the guidance notes and some key phrases I used. I am more efficient now when I get an appeal. This discussion has also reminded me of the importance of leaving anything written in haste and emotion and re-reading it later, or even getting someone else to read it. I have discussed it with my colleagues at our regular learning events analysis meeting.

ER: OK. So, what did you share with them?

EE: The data file so that they can also be quicker when they have appeals to support.

ER: That sounds really helpful (affirmation).

The appraiser enters a note of the discussion in appraisal documentation

Scenario 3

How this might be written up in the summary of discussion

Dr EE had chosen to reflect on a case where they developed a template to use when writing in support of a Personal Independence Payment (PIP) application, to help applications get through the assessment process. In discussion, it was clear that although frustration can be an uncomfortable emotion, it can also create energy and lead to positive action and change. Dr EE also reflected on the importance of allowing time before sending e-mails or letters in haste and so the discussion and learning went beyond the trigger incident. Sharing the learning points and future actions of the case with colleagues is an example of good practice.