Monday, April 23, 2012

Teamwork: For Better or for Worse

As a first year medical student looking into the future, I often wonder what it will be like not to fly solo, as we must to earn a grade in medical school, but to solve problems as a part of a health care team. This idea has been touched on, but not fully explored as of yet in my medical career, though it can be said to be an essential aspect of health care. I have personal experience with both the positive and negative sides of teamwork. When I was in the third year of my chemical engineering major, one of the required classes was a chemical engineering lab, Unit Operations (it was like a chemistry lab, except we used industrial sized equipment). The class was designed so that students were employees of a company and were sent “Memos” asking for reports or designs on different topics; the memos did not provide any instructions on how to complete the task. Students were divided into groups, and members of the group were assigned different jobs which changed for each lab: Planner, Experimenter, Analyst, and Consultant. The group had to complete a minimum 50 page paper every other week, as well as present every week on their progress to their “Supervisor”. Each member received their own score, but it was impossible to complete any one section if the other members hadn’t completed their own work. Unit Operations created a situation where you are only required to complete your job, but you are penalized if a member of your group doesn’t do their job. At the time I began this class, I was excited because we used real industrial-sized equipment, but I quickly learned the frustrations inherent in mutually dependent teamwork. I struggled in the first semester of Unit Operations because my group members did not pull their own weight, leaving me to pick up the slack if I did not want to be pulled down. Actually, in the end, one of my group members failed the class. However much work it was at the time, I truly learned how essential communication and follow-through are for successful teamwork. Now, the failed teamwork in that case led to a member’s failing the class (and poor grades for the rest of the team), but on a health care team, such failure could end up having a negative impact on a patient.
 I first encountered the importance of health care teams when my father became sick my freshman year of undergrad. He went to the ER with severe abdominal pains anticipating that it would be another blockage resulting from scarring from his past abdominal surgeries. However, the general surgeon and ER physicians he saw upon arrival discovered that he had acute necrotizing pancreatitis. As they couldn’t figure out why my father had pancreatitis (turns out the pancreatitis was a side effect or a reaction to his blood pressure medicine), and he was rapidly deteriorating, multiple other health care providers were called to provide assistance. These physicians included: internal medicine, GI, pulmonary/Critical Care, interventional radiologist, and ID. All of these physicians were needed to maintain his health until a decision could be made for a recovery plan. After three days with no progress, it was decided that he could not be successfully cared for in Sioux Falls, so he was airlifted to the Mayo Clinic where he was under the care of a whole other set of the same type of physicians caring for him in Sioux Falls with the addition of a thoracic surgeon, a general radiologist, a biliary surgeon, and a transplant doctor. It took another three days in the Mayo ICU surrounded by dozens of doctors, fellows, residents and nurses before someone finally realized the most likely cause of his pancreatitis. The blood pressure medicine was pinpointed and discontinued, and my father was able to leave the ICU two days later, though it took another couple of months before he was able to return to a normal life style. Throughout this ordeal, my father was frequently not aware of what was going on to him and about him; he did tell me two things he managed to notice, 1) that many times there were potential miscommunications between different doctors and between doctors and staff (nurse, respiratory therapists etc.) which luckily my mother was able to catch and 2) from the many doctors who assisted on his case, it was a GI doctor, who had clearly been in excellent communication with the other doctors, who first recognized the pancreatitis as a potential side effect of the medication and took control of my father’s care once he had stabilized.
My father’s case clearly demonstrates the need for inter-disciplinary collaboration, the need for improvement in the communication between physicians and other supportive health care providers, as well as the importance of family support. The IHI Open School was created to ensure that health care teams, like those that took care of my dad, can succeed beyond their current level. If the students of today truly learn to collaborate, then situations like my dad’s may not occur; instead of 6 days to figure out what was causing his condition, it could have been discovered in the first couple of days. Acute necrotizing pancreatitis is not something that is easily survived and it was only with the successful collaboration of multiple health care teams that my father is alive today.

- Laura Danielson is a first year medical student at the Sanford USD School of Medicine and is the editor of Unum Vox. 

No comments:

Post a Comment