I believe there is no better place to see teamwork in action than the inpatient setting. As a medical student, the teams in question can often be ill-defined. Yet the whole hospital is, in theory, built on that contract between healthcare providers and their patients. Patients bring their their health to the table, and we bring our expertise and commitment to their service. From that foundation arises every other collaborative effort in medicine.
After a year and a half of clinical rotations in medical school, I’ve grown familiar with the interactions between physicians: how different specialties operate and interact with each other, the valuable role of consults, and how different practitioners act given their rung on the teaching hierarchy. Yet I still only have the faintest idea of how our nursing staff operates. Or what the day-to-day role of a clinical pharmacist is. Or how physical therapist perform their jobs. I know that collaborations between these different medical professions is essential – unfortunately my main interaction with any other field is limited to the electronic chart. Following nursing notes, PT/OT evaluations, respiratory therapists comments, etc. I do think that for all the efficiencies brought on by the electronic chart, I’m missing out on the valuable interpersonal interactions that physicians used to have with each and every essential personnel.
In medical school the focus is on a successful evaluation of a patient and the knowledge needed to establish a differential and plan. But in learning all the theory behind our practice, we often overlook the reality of what we’re learning. I frequently catch myself not knowing what actually physically happens. SPEP? NAAT? I know when to order these labs, but have never seen the process actually performed. I’m ashamed to say that it had never crossed my mind how values like “moderate blood” on a urinalysis are measured. When I saw it actually performed in a lab, I immediately remembered the term dipstick, and it made a lot more sense. I felt foolish in that moment, but even that quick interaction with lab technicians had a huge impact on my thought processes when working up a patient.
As far as medications are concerned, I admit I am still unfamiliar with the nuances. I was floored when I experienced how helpful having a pharmacist on rounds was. I distinctly remember a tough case involving a patient with HIV on antiretrovirals who was suffering from an adverse drug interaction. The pharmacist began talking and everyone from the attending to the medical students stopped to absorb his expertise and navigating the situation. The financial cost of these medications is another essential area in which pharmacists bring invaluable insight. No matter how theoretically sound my ideas might be when presenting a patient plan, real world factors such as cost and availability dictate what kind of management can be pursued. Even something as simple as the fact that certain pills are just too big to comfortably swallowed – or too small to be split.
Nurses are the backbone of patient care. Whereas their roles may differ, the nurse is often the one actually carrying out the majority of medical interventions planned for the patient. Though nurses also spend lengths of time charting their activities, they are still the ones that understand the patient best. One of the single best strategies I developed in my 3rd year rotations was talking to nurses about my patients. They always had insights to share that would leave me more prepared than spending that time recycling through the chart again. So why is it exceptional to have a physician that includes nurses on rounds? Perhaps it is time to change the standard.
My interprofessional experiences across two hospitals have been eye-opening, but I know that they are not always the norm. Hospitals around the nation still suffer from the ideal of “doctor knows best”. In the end, a collaborative patient-centered effort will always lead to better outcomes. I hope that medical training will push more toward exposing each field to one another. To those reading this article, I’d like to know more about my colleagues. The nurses, physical therapists, and pharmacists I’ll be working with to achieve the same goal. I’d especially love to hear feedback on the interactions you have had with physicians, the good and the bad! I am sure that we can collectively strive towards improving our team.