Who is the Captain of the Care Team?

Amateur and professional athletes agree that there is little that compares to the joy of participating on a highly functioning team. Interestingly, the same applies in healthcare. 

It was a special experience for me as a practicing Nephrologist (now retired) to participate as a team member in a clinic devoted to the treatment of patients with chronic kidney disease, some of whom were headed to chronic dialysis. The culture in this clinic was all about the team: nurse practitioners, dieticians, social workers, pharmacists, doctors and patients working together. Every healthcare provider was there to meet the needs of the patient, as defined by the patient, during every visit. As the doctor, I was just one team member, no more important than any other. And the captain of the team? That was the patient.  

This is an example of how interdisciplinary team-based care puts into effect the Principles of Patient-Centred Care as laid out by Picker decades ago. Patients are provided education about their disease: its nature, its natural history, its treatment options (including conservative therapy only). Their questions are answered by the professional most capable of doing so. Members of the team come to know each patient as a distinct individual with a distinct cultural background and distinct social and financial circumstances, beliefs, support systems and needs. Through this interdisciplinary team-based care system, patients end up being able to fully participate in joint decision-making, even on matters so serious as choosing treatment or death. Their decisions are fully supported by team members who accept being directed by their legitimate captain. 

Patient satisfaction and clinical outcomes are better when patients are managed by interdisciplinary teams rather than by their specialist alone. Studies have shown that this applies to many clinical programs, such as those devoted to joint replacement, community-based maternity care and management of chronic diseases ranging from chronic kidney disease to diabetes to chronic lung disease to heart disease. This is not surprising as team-based care promotes person-centred care and this is well-known to enhance clinical outcomes and patient satisfaction.  

ICN believes it is important that citizens be engaged on matters related to healthcare and that this engagement should lead to an incessant demand for clinical care that features person-centred care. Interdisciplinary team-based care accomplishes this and increasing its prevalence will improve the quality of healthcare delivered. The trend is encouraging. The more the captain of the team demands it, the faster healthcare system change will occur. 

About the Author: Robert Bear is an ICN volunteer and Board member. He was previously a Professor of Medicine at the Universities of Toronto and Alberta, and is author of the medical novel “Sorrow’s Reward”.

February 2022

Credit: Pexels, Luis Melendez