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

Team Medicine

Up until recently, the one characteristic consistent through medical history was our working individually. The student of medical history will notice the achievement of notable individuals such as Osler, Kocher, Kelly, Hunter, Cushing, and many, many other individuals. Medicine has been so full of the cult of personality that we've almost deified some individuals.

team medicine Take, for example, the story of William Stewart Halsted. During the early 1900s, he was one of the principle founding physicians of Johns Hopkins Medical School. He was internationally famous as one of the greatest surgeons of the day and to this day, is considered the Father of Modern Surgery. Of course, there most assuredly were a number of others who worked with Halsted to help him become one of the most significant icons in medical history.

This same phenomenon has existed through much if not most of medical history…until today. Over the last several decades, medicine has become an increasingly team-based pursuit. Advanced technologies, specialization, and ever more complex knowledge has made it increasingly difficult for any one person to have all the answers or all the requisite skills to care for patients.

As a result, we are now moving inexorably toward a team approach in medicine. Podiatry as a specialty has, in many instances, been on the forefront of team medicine, for the simple reason that we treat a specific organ rather than the entire body. As limb salvage experts, for example, we easily work with vascular surgeons, plastic surgeons, endocrinologists, internists, radiologists, physical therapists, nutritionists, and a slew of others.

Tonight's Premier Lecture is
Arterial Pumps for Limb-Salvage and Wound-Healing
by Paul van Bemmelen, MD, PhD

We've now gotten to the point that the American College of Physicians recently published a position paper describing clinical care teams and describing principles with which these teams may successfully function (1). For your edification, here are the principles outlined in this article:

	1.	Responsibilities should be assigned based on the patient's best interest.

	2.	Patients should have access to a personal physician who is trained in the care of the “whole” person.

	3.	Teams should have the flexibility to determine the specific roles of the members.

	4.	Although physicians are well placed to lead a team, other members may function as leaders.

	5.	Various health care professionals in collaborative teams will be needed to address physician shortages.

	6.	Team members bring unique skills and experiences to the team which are beneficial in patient and family-centered health care.

	7.	The creation of teams will require specific competencies for the team members.

	8.	The team member taking on the responsibility of primary care must assume a certain level of liability.

These principles may seem somewhat generic or even esoteric, but the simple fact of their existence points to an institutionalization of the team approach to medical care that marks a significant change in philosophy.

team medicine The trouble I see with this is not the idea of team-based medicine (I am a strong advocate of it) but rather the low level of education most of us healthcare providers receive in working as part of a team.

One of my jobs with Western University of Health Sciences is to manage a pilot program teaching Interprofessional Education (IPE). My part is focused on the more advanced clinical students of our nine colleges, most of which have already gone through two prior years of training in IPE. One of the major goals of the program is to create competency in team-based activities. However, I'm often surprised by the lack of facility many students have in working with a team. Of all the participating colleges, only one makes a significant effort to teach teamwork outside of the IPE framework. That college is nursing.

team medicine If you were to compare all of the various caregivers in medicine, nurses are the only professionals that are situated for and exposed daily to team-based care. Think of the floor nurse in your local hospital. No one but that person seems to know all of the factors involved with a particular patient. Even more than the admitting physician, the nurse knows the patient's most intimate needs and personal situation, spending the most time with the patient, and working intimately with all members of the medical team. The rest of us providers have something to learn from the nurses.

I noticed this deficiency a while back when a group of professional students were tasked with a job that required a team effort. Unfortunately, despite two years of prior IPE training, in addition to their own personal life experiences, the group failed to function as a team. No one stepped up to lead the team, multiple members repeated the same work, and the group had no plan to succeed. The end result was not a success.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]