I want to be a good leader of my healthcare team. How would I know? Such a swirl of activity. This week my ophthalmologist wanted to refer to me another ophthalmologist. She said she’d email her to introduce me, send over my records, and have her scheduler arrange the appointment. I’ll follow-up if I don’t hear from the scheduler in a week. My chiropractor wants to hear what the massage therapist and physical therapist recommends and aligns his plan with theirs. My neurology nurse practitioner called me to say that the insurance company won’t cover the brand name injection I’ve taken for years because there’s a new generic medication. She doesn’t think it’s been tested enough on people before FDA approval. Instead she will prescribe a different dose of the brand name drug instead that’s still covered. Is that OK with me?
My healthcare team is like no other team in my life – not like family, not like business teams. It feels like a team in the clouds. They never gather together as a team. If they communicate at all it’s through me, or emails and snail mail reports, or if they’re in the same system through the electronic health record. I can think of once in 7 years that any clinician spoke to each other directly: my primary care doc called the neurologist when I fell and sustained a concussion. My wife has attended a couple of doctor appointments with me when I was first diagnosed with MS. Several times a year a prescriber speaks with a pharmacy or medical supply company to clarify an order. My family likes to stay current about my treatments, risks, appointments, and stress. They talk with me and among themselves.
Who is my team? Me, my wife, my sons and their families, my sister, my doctors and their teams, other clinicians (massage therapist, chiropractor, acupuncturist, physical therapist, optometrist, optician, pharmacist), medical supply companies, insurance company. I’m fortunate. I’m a good e-patient and I’m a clinician myself. I’ve selected this team (except the insurance and pharmacy benefit companies). One of my best barometers of team effectiveness is usually how the team operates when the leader isn’t in the room. Do they work better when she’s present or absent? Do the team members treat each other with respect? Is communication open? Are they clear about accountability, do they meet their commitments? But in healthcare there are so many other factors and power dynamics between clinicians, office staff, caregivers, insurance companies, administrators. It’s crazy complex – like being Secretary General of your health team. I wonder what Ban Ki-moon would advise?
Tx Joyce. I’d forgotten that you had mentioned this. Good coordination
As always, Danny, thoughtful and well stated. The ALS “community” has “Multidisciplinary Clinics” that manage PALS (patients with ALS). We went to one place and Vern was seen by every discipline in one room. They coordinated their times and gave us “time out” if he needed it. Obviously this did not include insurance co., pharmacy, etc, but it did include Neurologist, Pulmonologist, OT, PT, Speech, Nutrition, Social, Medical Devices. I don’t know if this would work for MS patients, but it worked for us, although it did make for a long day.
Hi. It would be interesting to ask each member(non family) of the team “how do you know ifyou are doing a good job?”