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Collaborative Teamwork in Medicine – What I’ve Seen, and Why It Is Important in Patient Care

Something I have always talked about with classmates, physicians, and really anybody that I discuss healthcare with is the important of collaboration in medicine. This can come in the form of working as a team with other doctors, nurses, PAs, pharmacists, and the list goes on. A team that combines the knowledge and unique perspectives of many provides the ability to see a clinical situation holistically and from many viewpoints. This may not only prevent the missing of important details and allow for the identification of certain factors in each individual case, but also to create a cumulative knowledge of all involved in the team that will find the best possible approach to providing excellent patient care.

I see this sort of collaboration every other week at my LP clinic with Dr. Robert Baiocchi, a hematology/oncology physician at The James. During my first day of clinic with Dr. Baiocchi, I noticed something that I had not seen before – instead of an island of computers where all the physicians work side by side, he worked in a room with his “team”, and he was the only physician in there. His team consisted of an APRN-CNP, an RN, a pharmacist, and a PCRM (patient care resource manager – a nurse case manager). What I immediately noticed was how valuable it is for him to have such a team to work with, and how it likely helps so many of his patients.

From what I have noticed, both with my own observations and from his patient feedback to me, Dr. Baiocchi is brilliant. He has a vast knowledge of the field, has excellent bedside manner, and truly is an excellent physician. While this is all true, he still discusses just about every single case with his team, ranging from the complex to the less complex. This is not to say that they have a huge drawn-out discussion over a patient coming in for a follow-up or check-in, but he makes the team an active part of the clinical decision-making process because each member of the team brings something a little different to the table. Whether this is regarding their history of cancer, the pathophysiology of their disease, their PMHx, drugs that they are taking/should be taking/should stop taking, or anything along these lines – they work as a unit so that their patient is as healthy as possible. Each member of the team constantly treats each other with a mutual respect for their contributions and individual bases of knowledge, with dignity, and with trust, which allows the team to be more effective in their determination of treatment protocols, and I truly believe that this is what contributes to improved outcomes in healthcare. It must be kept in mind that he absolutely does work and collaborate with other physicians, but this core team are always in close proximity and there to discuss and move forward with treatment together.

My experience in the hem/onc clinic with Dr. Baiocchi has shaped my view of clinical practice in that I can see the value of having such a team around me at the hospital. Sometimes, physicians may overlook something, or may forget something, or may not have seen something for years, or may simply have never learned something. Having such a team around them with carries a mutual sense of respect, dignity, and trust will only come to help his patients, as well as make it more enjoyable to go to work and to practice medicine. I hope to emulate this sort of teamwork in my future practice, for the betterment of both myself and the patients I will treat.

Kids are Good at Adapting

Patient Care – Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

When I think of patient-centered care that is compassionate, appropriate, and effective, I typically imagine utmost empathy and communication skills that makes a patient feel comfortable, informed, and permits the best possible outcome. I had the privilege to witness and learn from such care during my Neurology Consults rotation from my chief resident, Dr. Mark Pierce. The way Mark interacted with all of his patients was nothing short of impressive – I have yet to see someone with his incredible bedside manner, an ever-so-delicate mix to compassion, knowledge, humor, and a desire to truly help people. There are a vast array of examples I can think of in which Mark exemplified what it means to truly be an example of outstanding patient care, but there is one example that specifically stuck out to me.

One of my patients that I had been following with the intern on our service (not Mark initially) was admitted with a chief complaint of sudden onset left lower extremity weakness causing her to fall, as well as sudden onset dysarthria due to “tongue paralysis”. These findings are quite confusing – what could cause these 2 specific lesions but no other focal findings? Why was she dysarthric on admission with apparent 1/5 strength in her left leg, but no other findings on admission, no past history of neurological problems, no obvious signs pointing in one direction or the other?

Following my H and P, as well discussion with the team, we did an extensive workup on her, which included labs, various imaging modalities, and an EMG. What did we find after all of this? The answer, as we were shocked to find out, was nothing. Well, maybe we were not shocked… I did have one sneaking suspicion in the back of my head from the beginning, but in order to rule this in, we really had to rule everything out. This patient, a transgender patient with history of recent assault and history of depression/anxiety, had what seemed to be risk factors for psychogenic disease. However, this is a diagnosis of exclusion, and organic causes of physical manifestations must be ruled out before making such a diagnosis, as my chief made very clear to me.

Before going to talk to the patient about this with me, Mark gave me an incredibly powerful talk on the quintessential psychogenic disease patient. Roughly repeating back what he so eloquently stated, “Let’s say you have a young child, maybe 4-5 years old. Kids are bad at things, right? Kids can’t really drive a car; they can’t smoke cigarettes; they can’t really drink; what can kids do? What are kids good at? Kids are good at ADAPTING. Kids are good at adapting to various situations in order to keep moving forward. So let’s say you have a kid that is under a lot of stress. This stress could be from one of many forms of abuse – physical, mental, psychological, emotional, sexual – or it could be form anything that they simply perceive as stress or abuse. So this child has this going on, but they still nonetheless have the same expectations set upon them from society as other children – they need to be a good kid, go to school, do well in school, eventually maybe go to college, get a job – but they have this weight on them in their mind from their stress. So, what do they do? They adapt. They are able to work through this stress, and maybe even successfully bury it. And they can live with this for a while, with this stressed out child buried deep within them. But eventually, in some, a trigger later in life – whether from an assault, a hit on the head from a softball, or any other type of stressor – can ‘wake up’ this inner stressed out child, and can manifest with actual, physical, real symptoms. And it must be stressed that these are real symptoms – the patient is not faking it. Rather, this energy that was buried deep down is manifesting itself as a medical problem, especially things like weakness, syncope, seizures, and the like, and the only way to tackle them is to approach the deep-rooted problem head on, to talk to that inner child and try to work through those issues.”

Now, this is not verbatim what Mark said to me, but it’s pretty close, and I was totally blown away (my mouth was physically hanging open). After he said this to me, which I thought was just for a teaching point, we went to see my patient. Much to my surprise, he took a chair, sat down next to her bed, and restated this entire scenario to the patient. He then said this: “This may seem like an odd question, but… how was your childhood?” The patient ultimately replied: “Bad.” And so a productive, empathetic, compassionate, trustful conversation unfolded between resident, student, and patient, and a path was paved forwards towards treatment.

While I have tried to understand what can contribute to a patient’s situation, and communicate this with them such that I can provide them the most empathetic care, I have never had the opportunity to do so in such a way that I saw on this day with Mark and this patient. The patient seemed so relieved to hear this from Mark, and to talk about everything with us – it seemed like the first time she was heard and understood, and not written off because it was “all in her head”.

I aspire to be able to communicate and empathize with my patients in the future in a similar manner. This is extremely important to me, as I believe that it is this connection that will allow the best possible outcomes and best possible patient-physician relationships to form. I believe that the best possible way to do this is to always consider ALL potential causes of disease in a patient, all circumstances that may contribute to their condition (i.e. risk factors, SES status, psychosocial issues), and to be as holistic as I can be. I believe this is a realistic goal, and one that I can start implementing immediately as a medical student when interviewing patients, putting together a differential, and creating an assessment and plan. I hope to one day be as effective of a physician and communicator as Mark, and will work to do so.

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