Thursday, June 7, 2012

How would you rate your health care team?

Two recent commentaries in the Annals of Family Medicine and the New England Journal of Medicine argue that the performance of modern family doctors can only be as good as their practice teams. In "The Myth of the Lone Physician: Toward a Collaborative Alternative," George Saba and colleagues explain why the myth that a primary care physician can do it all alone is dysfunctional and outdated, and should be replaced with the paradigm of a "highly functioning health care team":

What will be the roles and responsibilities of each team member? What systems and skills are needed to ensure effective communication? How will decisions be shared? How will conflict be resolved? How will the team foster trust and respect? How will the team promote the development of meaningful healing relationships? How will the team evolve over time? The specific answers to these questions define the roles and tasks of each team member, and the collaborative process of working through these challenges strengthens team relationships.

Similarly, in "Sharing the Care to Improve Access to Primary Care," Amireh Ghorob and Thomas Bodenheimer assert that the only way for physicians to meet the health care needs of a burgeoning and increasingly complex patient population is to delegate many of their traditional responsibilities - such as "patient education, lifestyle counseling, medication titration, and medication-adherence counseling" - to other health professionals:

The paradigm (culture) shift transforms the practice from an “I” to a “we” mindset. Unlike the lone-doctor-with-helpers model, in which the physician assumes all responsibility, makes all decisions, and delegates tasks to team members, but the capacity to see more patients does not increase, the “we” paradigm uses a team comprising clinicians and nonclinicians to provide care to a patient panel, with a reallocation of responsibilities, not only tasks, so that all team members contribute meaningfully to the health of their patient panel. Non-clinician team members must add capacity in order to bring demand and capacity into balance.

In the current issue of Family Practice Management, Berdi Safford and Cynthia Manning discuss "Six Characteristics of Effective Practice Teams," which include shared goals; clearly defined roles; shared knowledge and skills; effective, timely communication; mutual respect; and an optimistic, can-do attitude. How many of these characteristics does your doctor's office embody? Would you say that they currently function as an effective health care team?


A slightly modified version of the above post was first published on the AFP Community Blog.