Interprofessional Collaboration: Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care
- Objective 7.2: Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served.
- Objective 7.3: Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual patients and populations.
One of the most rewarding experiences I’ve had as a student took place with a patient who I cared for on my mini-internship experience on the infectious disease service. I had the privilege of working with her and her family from admission to discharge as they navigated a complex hospital experience over almost three weeks.
My first encounter with this patient and her family took place during night call during my third day on service. She was 16 years old and initially presented with weight loss and a very large pleural effusion of subacute onset. She and her family were Nepali, and her parents spoke a limited amount of English. With the help of an interpreter, we learned that she also had a history of previously treated latent tuberculosis as well as a BMI less than the first percentile for her age due to restrictive eating behaviors. We were concerned for active pleural tuberculosis, and we began an infectious workup for this and other organisms.
However, her hospital course quickly became complicated for a variety of reasons. On her second day in the hospital, the team placed a chest tube to relieve her large effusion. This resulted in post-obstructive pulmonary edema that required several days of high flow nasal cannula oxygen in the PICU. Though she recovered from this in several days, she was weak and malnourished at baseline, which worsened with her acute illness. To further complicate matters, her previous history of latent TB made it difficult to interpret her TB quantiferon gold test, which was positive. We ordered a variety of PCRs and cultures of her blood and pleural fluid instead, but though the fluid was exudative they were all negative for organisms. It soon became clear that we were going to need other teams on board to help make a diagnosis.
Our initial thought was to get a biopsy of her lung pleura as this was where the disease process seemed to be localized. I consulted the general surgery team; however, they were concerned about her post-operative recovery given her poor nutritional status and worried she would develop a pleural leak that would compromise her respiratory function. I then reached out to pulmonology to get broncho-alveolar lavage samples for microscopy, PCR, and culture. They were able to safely complete this procedure, but it again yielded no answers. With so many negative infectious studies, we began to consider additional causes for her presentation. I consulted rheumatology and ophthalmology who evaluated her for autoimmune causes, which were also negative.
Throughout the patient’s hospital stay, I worked with other teams to address additional health and social issues. Hematology helped evaluate and treat a severe iron-deficiency anemia present on admission. Adolescent medicine and nutrition both worked with the patient to further investigate her restrictive eating behaviors and optimize her nutrition. Social work helped her parents fill out lengthy paperwork to secure a leave of absence from work during her admission. Child life worked with the patient to help fill the long days with interesting activities. Psychology was consulted to help her process her illness and lengthy hospital stay.
Ultimately, weeks went by without answers, and though we were unable to confirm TB with lab tests, it was deemed most likely based upon her clinical presentation, risk factors, and failures on trials of several empiric antibiotics. She was started on empiric four-drug therapy just over two weeks into her admission, and within 24 hours, she had her first day fever free since arriving to the hospital. Her clinical status continued to improve on TB treatment, and we moved forward with this presumptive diagnosis. I called the Ohio Department of Health to coordinate direct observed treatment and worked with the patient’s family to clarify home- going instructions and follow-up.
Throughout this patient’s stay, I spent many hours communicating with the multiple interprofessional teams involved in her care. I then communicated the information I learned to my team as well as to the patient’s parents and nursing staff. As I worked with many different specialties, I found it particularly challenging to communicate the patient’s complicated hospital problems in a concise manner that emphasized the points relevant to specific consultant teams.
As I’ve reflected on my experience caring for this patient and her family, I have considered the ways in which my skills in communicating with interprofessional teams have developed over the past three years. During my first two years of medial school and into the first part of my third year, I felt like much of my progress in communicating with different providers involved learning the basic language necessary to have discussions about patient care such as rounding and basic note writing. Initially, as I worked on developing these basic communication skills, I sometimes struggled to “take ownership” of patient care by contributing to interprofessional care:
Evaluation from UPWP GI rotation; June 2020
As I’ve gotten further along in my training, not only have I learned how to provide more comprehensive care for my patients by communicating with consultants— I’ve also learned more about which specific details of such communications that are valuable to certain care teams: For example, a general surgery consultant, a rheumatologist, and a social worker may all be interested in different aspects of the same patient’s history. Working as a part of some of these teams myself and interacting with different members of the interprofessional care team have helped me become more adept at developing this skill. Some of these skills began developing during my third year as I starting interacting more often with interprofessional teams and asking them to teach me more about their roles in patient care:
Evaluation from UPWP Pediatric Ambulatory rotation; September 2020
As I became more comfortable interacting with interprofessional team members and consultants, I gained confidence in reaching out to them to facilitate more comprehensive care for my patients. During this most recent experience on pediatric infectious disease, I was proud of the hard work I put in to follow up with consultants regarding my patient’s care needs and of the long hours I spent with the patient and her family explaining various aspects of her care. I felt as though I had made the effort to take ownership over my patient’s care as the designated caregiver from her primary team. When I got feedback from the ring, it was gratifying to see that physicians I worked with noticed this effort, too:
Evaluation from AMHBC: Mini-internship in Pediatric Infectious Disease
Continuing into my final year of medical school, I hope to keep working toward improving my ability to collaborate with members of an interprofessional team. As I get closer to becoming an intern, I plan to take ownership such conversations for my patients whenever possible and to be intentional about touching base regularly with teams such as nursing and PT/OT who carry key knowledge about important aspects of patient care. In this way, I hope to both gain knowledge as a student doctor and become a better caregiver for my patients.