Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

The Benefits of Team Medicine

Last week, I heard an interesting radio interview of a motion picture movie writer named Zak Penn. During this discussion, Mr. Penn made an interesting comment about how Hollywood moguls typically want their writers to sit in a room without talking to anyone and write the screenplay for their movie. Mr. Penn differed with this perspective, commenting that he found greater success working collaboratively with storyboard artists, special effects experts, and others. This conversation struck a chord with me. It seems increasingly that the idea of collaboration is becoming ever more important in various professional fields. This is especially true in medicine.

In my own practice of podiatric medicine and surgery, working with a large variety of partners has been quite beneficial and much more interesting than when I was in sole private practice. During my first years in practice, my surgeries were done only by me and a scrub tech. This solo surgery style had the benefit of giving me the confidence and ability to function without a bunch of helpers (I didn’t have students or residents at the time either). However, the downside was the lack of collegiality, the give and take that occurs when someone of equal training is present. On the rare occasions that I’d work with another surgeon, I always found the case to be more interesting, and I’d learn something new, whether a different procedure or different version of a familiar procedure.

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Today in practice, I have multiple partners of varying experience and training, and each time I perform a surgery with one of them I learn something new. Additionally, I find I have better overall results. This makes perfect sense if you think about it for a moment. Surgery of all kinds is highly complex with many steps, each of which has a significant effect on the end product. Having a second set of highly trained eyes is like an airline pilot having a copilot, someone there to watch out for the untoward.

When I was a resident, there was a pair of attendings that always did surgery together, no matter the complexity of the case. The residents generally took issue with this, some of them perhaps losing respect for these surgeons. But looking back, these doctors may have been on to something. Whether each understood his limits, or they felt they needed a crutch, they always had that second doctor watching out for complications.

Medicine in general is moving increasingly toward this collaborative method with interprofessional medicine. I’ve written about this previously, referencing an initiative at Western University called the Western Diabetes Institute, which is an Integrated Practice Unit taking care of diabetic patients. Their patients benefit from seeing two or more providers at the same time. Imagine the quality of your medical care if you saw your primary care doctor who then, at the same appointment, grabbed your orthopedic surgeon to immediately see you regarding your shoulder or knee pain? How good would it be if she then immediately “refers” you to a physical therapist who then immediately walks into your room to establish care? And all this time, all of your providers have immediate access to each other to discuss your case? That is quality, coordinated care!

I’ve had several similar experiences, whether working with the folks at the Western Diabetes Institute or at a local county hospital. At this particular hospital we share clinical space with the surgery department, and in the past, during one of my clinical days I would be in the same hallway as a vascular surgeon. We constantly conferred about a variety of patients, often seeing these patients simultaneously. This is a much more vibrant, interesting, and higher quality way to practice medicine. For those of you in private practice just think about those PAD patients you see who you feel need a revascularization. If you want to speak to the vascular surgeon, you have to call, wait for them to come to the phone, and then discuss the situation without the benefit of both of you being in the room with the patient.

It’s not optimal, but it’s the way we’ve done medicine for so many years, each of us stuck in our silos, rarely interacting with other physicians and providers, repeatedly ordering redundant tests, prescribing overlapping medications with the resultant polypharmacy complications, and inadvertently giving our patients less effective care.

I applaud those on the forefront of interprofessional, integrated care. We’ve seen the benefits of this type of care in the podiatric world. Our specialty has been involved in multidisciplinary care for quite some time when it comes to our diabetic patients. This is, as we all know, one of the high marks of podiatry. Our profession’s work with vascular surgeons and the team approach to diabetic limb salvage is something in which to be proud. We need more of this type of work.

For me, I’m excited for what the future holds both institutionally and personally when it comes to partnering with other healthcare providers. In the end, it’s our patients that benefit.