Wednesday, December 5, 2012

There Is No "I" In Team

I’ve been pretty frustrated lately by all of the backpedaling I have to do as far as my health is concerned.

I feel like the main problem is that I don’t have a medical team. 

I have a group of doctors that I see, that are responsible for my care, but they are not a team. 

I have a primary care doctor, a rheumatologist, a nephrologist, a gastroenterologist, a psychologist, a psychiatrist, an ear, nose, and throat doctor, and a neurologist.  Some of those doctors I do not see regularly, like the ENT and the neurologist.  But the others I see multiple times a year.

However these doctors exist in isolation of one another.  They don’t talk.  They barely know each others’ names.  And they are in the same, albeit large, medical system.

And this is hurting me.

One hand doesn’t know what the other is doing.  And this often means multiple calls and e-mails to multiple offices about the same issue. 

And lately it seems like nurses are on a power trip and are opting to make decisions without consulting the doctor.  I’ll have another post on this later.

But suffice it to say that I can’t do it all.  I can’t interface with all doctors and get the message across to all the others. 

There is no “I” in team.

Right now I feel like I am a team of one.  And that’s not really working.  One person does not a team make.

That isn’t to say that I don’t have an unofficial team around me, like my boyfriend, family, and friends, who I am sure would advocate for me should I be unable to do it myself.

But I don’t have an official, expert team. 

A group of experts is great, but not when they don’t work together.  In fact, it seems that this can be counterproductive. 

The point here is that a medical team is essential.

The idea of an interdisciplinary team in the medical setting is not a new idea (De Wachter 1976; ).  Neither is considering the patient to be an essential part of that team (De Wachter 1976).

According to one article, “Communication failures are the leading causes of inadvertent patient harm.  Although medical care is delivered by multiple team members, medical quality and safety has historically been structured on the performance of expert, individual practitioners.  Effective communication and teamwork have been assumed, and formal training and assessment in these areas has been largely absent” (Leonard, et al. 2004: i85).

We should also do well to remember that pharmacy technicians are also a part of our medical team.  I’ve had a lot of issues with prescriptions and pharmacies lately.  I was out of town, and because of the holiday, and when my pharmacy reopened, they were out of the medication, so I ran out of medication on Thursday and didn’t get the medication in the mail until Monday.  This is the longest I’ve gone not taking this medication.  I don’t blame the pharmacy completely. 

But my frustration, yet again, is that so much of my well-being is in the hands of others, and that does not fill me with confidence.  And when it is totally out of their hands, it is totally overwhelming for me. 

Lines keep getting crossed, things keep getting messed up, and I feel lucky that I am on top of my care enough to be able to know when errors are being made.

But I also worry about those who are not as much in control, for whatever reason, and don’t know that things aren’t the way they should be. 

I do know that my PCP and rheum do talk to each other, which is a huge relief for me, and has been helpful.  Despite this, my PCP often tells me to ask my rheum or talk to my rheum or try and get in to see him.  And then I get told that I can’t be seen sooner than my appointment that is three months away.  Then I e-mail him directly (and subvert the system) and get in earlier.  Only because I need to see him.    

So how do you create a medical team that is willing and able to work for you?  It’s great to have experts, but experts with disparate goals doesn’t do all that much.  One of my goals for the New Year is getting my healthcare back on track.  That may mean having to find new members of my medical team.  But it definitely means finding a way to get all of my medical professionals on the same page.  Or at the very least, communicating with each other, with my pharmacies, and seeing me as an inherently important part of this so-called team.      


De Wachter, M. 1976. “Interdisciplinary Teamwork.” Journal of Medical Ethics 2: 52-57.

Firth-Cozens, J. 2001. “Cultures for Improving Patient Safety Through Learning: The Role of Teamwork.” Quality in Health Care 10 (Supplement 2): ii26-ii31.

Leonard, M., S. Graham, and D. Bonacum. 2004. “The Human Factor: The Critical Importance of Effective Teamwork and Communication in Providing Safe Care.”  Quality & Safety in Health Care 13 (Supplement 1): i85-i90.

1 comment:

  1. Wow. Your coping strategies are exhausting in themselves. A more burdensome system could not be created by design. Thank you for sharing your story and raising a crucial healthcare issue. My hope is that the requirements and incentives of the Affordable Care Act help to move toward better outcomes, which themselves require more collaborative efforts (e.g. Shared medical records via EHR). Practicing in silos is no way to do medicine.