By Alec Pruchnicki, MD
One of the very first things I learned in medical school, when I started to take care of patients in Jacobi hospital, was that when you are working with a very good nurse treat her like gold. She, and it always was a women then, will make your job easier, your care for the patients better, and will correct you when you make mistakes or do something stupid. This was my introduction to the concept of a team approach to patient care, in spite of the fact that many doctors were still convinced that the world revolved around us and other staff members were just there for our convenience.
The team approach that Bill Dienstag describes, in detail, in this issue is something that many health care providers of all levels understand. Complex cases, like sophisticated cardiac interventions, or complex patients, like the geriatric people I care for, often require a wide ranging multi-disciplinary approach. The technicians, nurses, aides and social workers who care for the cardiac patients he describes are similar to the team members I work with in the assisted living facility where I have my office. At eleven AM from Monday to Friday we have a team meeting which usually includes the head administrator, the top two nursing supervisors, the supervisor of the personal aides, two social workers, the head of the dining room, the recreation therapist and myself. Once a week we are joined by the occupational and physical therapists, the home nurse supervisor, and the dietician.
The purpose of all this time and energy is communication. Problems seen by the staff can be communicated to me quickly, and I can send the word to the entire staff about a patient’s new medical condition, medication or other important details. There is a lot of information needed to care for complex conditions, like cardiac emergencies, or complex patients, and this must be shared quickly and accurately.
But, there is a problem with this approach. At the very least, it requires a lot of time and energy to be this thorough, in a field where time is often in short supply. These teams can sometimes take years to develop in order to get the right fit of personalities, expertise, and philosophies of care. Then there is the inevitable staff turnover and an occasional overhaul or house cleaning by new management, which is described in the Dienstag article. Developing and maintaining a good team is sometimes difficult.
There are lessons here for the general public also. You may not need an entire team to handle your medical problems right now, but you should have a trusted doctor or nurse practitioner as your primary care provider (PCP). Depend on this person to help you.
When I was on the staff at St. Vincent’s, I was on a first name basis with many of the specialists that I used as consultants for my patients. I could contact them to ask questions, give them further information, or even call in a favor when I needed a fast response time on a patient’s needs. When St. Vincent’s closed, I lost all this and it has been hard to completely replace this network.
Your PCP may have a similar network or team of consultants, technicians, nurses, etc, and sometimes that can give you the best chance of getting someone who will meet your needs. I, and most physicians, would never pick a specialist for myself based on a magazine list of “Top Doctors” or some internet website or ranking. Remember, the highest ranked doctors are sometimes the busiest ones also, and they may not have the time, or even the personality, to listen to you and give you the attention you want.
And, when you find a team that meets your needs, you might not need to treat them like gold, but at least realize that teamwork and communication gives you the best chance of getting the care you need and deserve.
