tag:blogger.com,1999:blog-2308282620289958037.post8616760461470434916..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: Rethinking multidisciplinary careThe Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-2308282620289958037.post-3384265983803701002010-09-21T12:10:29.177-04:002010-09-21T12:10:29.177-04:00One benefit to the patient or a "multidiscipl...One benefit to the patient or a "multidisciplinary team" is convenience. The patient gets to see all the "experts" related to his or her care at once. This is often a "selling point" used by such clinics to attract patients. <br /><br />But like the improved communication among providers that the MC discussed, this benefit is likely not worth the added cost.Medical Residentnoreply@blogger.comtag:blogger.com,1999:blog-2308282620289958037.post-51507668644194168342010-09-18T00:06:46.347-04:002010-09-18T00:06:46.347-04:00Multidisciplinary health teams also suffer from fu...Multidisciplinary health teams also suffer from fundamental management problems in a field where individual judgment and responsibility have always been paramount and will always be necessary. Teams of any sort first and foremost have to have a leader both for direction and accountability and so no matter how much of a cooperative approach is anticipated under this proposed paradigm there will still be one individual who is responsible for authorizing the execution of care plans. In one sense then the multidisciplinary approach is no different than the present system of a primary service and contributing consultants except that we put them all in a room together at the same time. It does however entail significant risks where the formal stipulation of a team leader who lacks in leadership qualities results in a diffusion of responsibility with concomitant chaotic management or an autocratic management style that results in a dysfunctional team dynamic. A similar dysfunctional situation results when the team players are not team players and medicine is a field in which individual ability and judgment and a heightened sense of personal responsibility are essential characteristics for its practice. With a diffusion of responsibility weak or lazy physicians can coast and not be fully committed to the team; arrogant and insecure physicians will engage in disruptive or self-protective behavior; and competent physicians faced with such dysfunctional dynamics with find ways to withdraw. Teams must first function as teams and only leadership can generate and maintain teamwork. Leadership of this type, which the military best exemplifies, is something an institution must select and train individuals for right along with acquisition of other professional skills and do so from the outset of their entrance into a profession. There would need to be sea change in medicine from the admissions process onward to acquire and train leaders to implement an efficient and effective multidisciplinary approach as envisioned. I do not believe this is either possible or necessary. Good cooperative relations between various specialists accomplish the same thing without geographic localization and enforced time commitments. These relationships come about naturally as physicians select out who they find most capable and accommodating to their practice perspectives and style. And in my experience rarely is there ever a true need for a collective meeting of multiple specialists in the clinic or at the bedside to examine and treat a patient. Many of the present day multidisciplinary clinics are more marketing than medical management providing only an illusion of higher intellectual effort. Unfortunately this illusion has great appeal in certain elite circles in and outside of medicine, with no consideration to the cost considerations mentioned above.Chauncey McHargue M.D.noreply@blogger.com