Current Issue
Spring 2014
BMM Current Issue
Download PDF
Herding Cats
Collaborative care teams offer joys and challenges
It’s 8:30 on Friday morning and once again we are behind before we’ve started. I can’t log onto the computer, half the team is missing, and our agenda is swelling with last-minute additions. My internal voice is exasperated. Why does this happen every week? Why can’t we get this routine down?

Then in a rush everything comes together. The computer cooperates and the room comes alive with the bustle of arriving people. We spend a few minutes exchanging hellos, sharing stories of our week, relaxing and connecting in the way that makes this team and our work possible. This moment is why I love my team.
I haven’t searched the literature that doubtless exists on the functioning of multidisciplinary teams. Perhaps someday I will. Nevertheless our motley crew has found its way through deliberation and luck to an equilibrium that works.

Our team was born of a need to better serve patients with eating disorders. Since so many different disciplines address this illness (medical, nutrition, counseling, psychiatry), coordination among providers is essential. You can either spend a lot of time playing phone tag or get everyone in the same room for a discussion. Spurred by the arrival of a therapist with experience at a specialized treatment center, our powersthatbe recognized we had all the components for a multidisciplinary team—we just needed to start working together.

At first we spent a lot of time discussing structure. Who would comprise the team? How often would we meet? Who would set and run the agenda? How and what would we document? How would
we handle sharing of information between the organizationally separate counseling center and medical clinic? What kind of therapy groups should be offered? Would patients have to see everyone on the team or could they see just nutrition, just medical, or just counseling? What would we call ourselves?

Once we started meeting, we had to figure out how to work with each other. Some members came with decades of experience. Others were newcomers on the upward slope of the learning curve. Some had worked with multidisciplinary teams before; for others this was a new experience.

We spent the first several months learning the mechanics of discussing cases: how to share enough information while keeping discussion moving forward, knowing when we needed to take more time to get it right. We got to know everyone’s personality and clinical temperament and taught each other about our respective disciplines. We rejoiced together when patients improved and released our frustrations and fears when patients remained stuck or worsened.Occasionally we encountered conflict over treatment recommendations and worked through awkwardness when offhand comments struck too close to home. We adjusted as team members left and were replaced. With every meeting our respect for each other deepened and our team cohesion grew.

Going into this project, I knew patients would benefit. But I was unprepared for how much I would benefit— personally and professionally—from being part of a team. I now have colleagues who are with me in the trenches, who understand the challenges of this work and provide a sounding board, an attentive ear, or a comforting hug. When my patients are in crisis, I can “phone a friend” to arrange urgent counseling or nutrition evaluation; other team members can call me and our other physician for urgent medical evaluations.

Instead of burning out doing difficult work, we sustain each other, reinvigorate each other, make possible work that is worth doing. We are integral parts of something bigger, something with purpose that makes patients’ lives a little better. In the end, that’s what medicine is all about.

Comment on this Article    Email this Article     Print this Article    Bookmark and Share