Volume 196 - Issue 4
Too much care — not enough love?
Author: Ian Charlton
Med J Aust 2012; 196 (4): 278. || doi: 10.5694/mja11.11272
Published online: 5 March 2012
Published online: 5 March 2012
Could multidisciplinary team arrangements be making patient care inefficient and doctors uninvolved? A heading on the front cover of the Journal in 2011 (“Putting the love in - to patient care”) suggested that somewhere inside ...
Could multidisciplinary team arrangements be making patient care inefficient and doctors uninvolved?
A heading on the front cover of the Journal in 2011 (“Putting the love in — to patient care”) suggested that somewhere inside would be found an article relating to putting the love into patient care. Try as I might, I could not find the love, but instead found an article by Best on team care.1 His somewhat lukewarm support for team care revived my worst fears about it, as this, unfortunately, is the very model of a loveless modern medicine.
The multidisciplinary team has more or less arisen by default, with the number of medical practitioners failing to meet the increasing demands of a population ever hungry for medical services. The situation is not helped by an increasing range of vaccines, the need for certificates to validate even routine activities such as exercise classes, and an ageing population who often have several coexisting medical problems. Changes in the medical workforce have exacerbated the problem, with some medical graduates choosing part-time work and limiting their after-hours availability.
Doctors have employed computers to manage the increased information load, but unfortunately this adds several minutes to each consultation and reduces the number of consultations that can be offered in a day. This reduction is compounded by older patients with multiple problems needing extra time. It all adds up to longer and fewer consultations by the general practitioner.
This scenario was allowed to develop over 15 years, until it reached a tipping point when it was suddenly recognised that there was a shortage in the medical workforce and an immediate political solution was required. In an attempt to handle the dilemma and to increase through-put, allied health workers have been brought into the equation. GPs are encouraged to work in teams, sharing their information electronically and allowing the smooth transition of patients through these one-stop shops.
It’s a fantastic model on paper.
Unfortunately, it has resulted in our elderly patients attending their GP on Monday, physiotherapist on Tuesday, podiatrist on Wednesday, pathologist on Thursday and the diabetes educator on Friday. In between, they may also go to respiratory rehabilitation for their asthma and a dietitian for their weight gain. And now, added to the mix, will be nurse practitioners. Cheaper to employ but just as expensive for the government, with their higher rates of review and test requests.2
Each team care member may provide first-class professional care, and probably has a better grasp of their discipline than the GP, but unfortunately each will say something slightly different to the others, and for a patient with some cognitive impairment, poor eyesight and poor hearing, a muddled merry-go-round often results. Now, with their calendar full of medical appointments, the patient doesn’t even have time for a picnic.
They won’t always mind this whirl of activity; the attention often fills a void in this part of their lives. As families become more dispersed and both members of a young couple are encouraged to work and find other fulfilling activities, there is sometimes no one to drop in on mum and dad. Fortunately, taxes paid by the working children can go towards employing carers to visit our patients and provide some of the love that is really needed.
And there’s the rub. Many of our patients find themselves engaged in the health system not only for illness, but for something to do and to find someone who will take an interest in them, listen to their stories and share a joke or a smile. Where is the love?
Family doctors used to travel with patients over 20 years, sharing their ups and downs. There is a danger now of them being replaced by a multidisciplinary team intent on efficiencies and item numbers.
Please, can we just focus on what works? One doctor, one nurse, one receptionist. Certainly, encourage them to work in group practices and share the after-hours work, but also encourage them to be part of the community and not some functionary health retailer.
This is a proven model and should be reinstituted as the principal model of family care. Governments would have to train more doctors and doctors would have to be rewarded for working this way. It’s only then that our patients might feel the love.
Competing interests
No relevant disclosures.
References
- Best JA. Keeping the connection. Med J Aust 2011; 195: 214. 0_i1115590
- Kinnersley P, Anderson E, Parry K, et al. Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting “same day” consultations in primary care. BMJ 2000; 320: 1043–1048. 0_i1115592
Provenance: Not commissioned; externally peer reviewed.