A mildly unkempt patient with a history of diabetes, hypertension, tuberculosis, asthma, chronic bronchitis, recurrent urinary tract infections, malnutrition, severe anxiety, multidrug allergies and mild bradycardia on today’s electrocardiogram presents for a repeat excision of her relapsed lung cancer after a trial of chemotherapy.
Her pre-op nurse informs me that she is concerned because my patient is apprehensive and that one of the nursing assistants believes he saw our patient take “a Tic Tac.” I scrutinize her medical records, which comprises of notes from her oncologist, surgeon, family physician, endocrinologist, cardiologist, pulmonologist, urologist, previous anesthesiologist, infectious disease physician, psychiatrist, radiologists, nurses, pharmacist, dietician, physical therapist, respiratory therapist, and psychologist.
Taking into account all of my patient’s history, I calm down my nervous patient, confirm her medical history, and discover that she has been homeless for the past 2 weeks and recently began self-medicating with unprescribed pain medications. Before presenting my patient to my attending physician, I factor in the concerns and recommendations of her other providers to develop an anesthetic plan that caters to and optimizes her perioperative needs and alert the primary team of our patient’s new circumstance to involve social services with her care.
One of the many reasons why medicine is an intriguing field is because there are innumerable combinations of ways patients and their disease processes can manifest. It is not atypical to care for patients with extensive co-morbidities that require the expertise of various healthcare professionals. Piecing together the often complex puzzle composed of the needs of our patients is a humbling process that beseeches cooperation between healthcare professionals because no one individual is capable of being an expert in all areas.
Regardless of our cognizance, interprofessional practice and education (IPE) form a key aspect of improving patient outcomes and safety. IPE remodels fragmented care into integrative team care by encouraging open dialogue and delegating specific roles among all participants of a patient’s care. This anecdote underscores how imperative IPE is to managing patients, especially those with multiple co-morbidities living under onerous psychosocial circumstances. It was through the clue picked up by our patient’s pre-op nurse and assistant that we uncovered vital information that impacted her acute perioperative and long-term care. And without the input and recommendations by the other healthcare professionals in our patient’s medical records, our patient may not have been medically optimized enough to survive her surgery in light of her other illnesses.
Evidence supports the notion that IPE is necessary to improving patient outcomes and safety. A 2014 meta-analysis and systematic review of 36 randomized controlled trials by Tricco et al noted that interprofessional collaboration yielded a greater than 30% decline in emergency department visits and hospital readmission by 19% in patients with chronic conditions. A 1999 study by Leape et al discovered that the presence of a full-time pharmacist on rounds was associated with a 66% decline of preventable adverse drug events in intensive care unit patients. A 2011 study by Chomienne et al highlighted that over 77% of patients reported increased confidence in handling their medical problems with the support of psychologists. These studies are just a few of many papers that emphasize how the growing trend of deliberately integrating IPE improves patient care.
Often designated as the team leader in the healthcare field, we future physicians are behooved to educate our colleagues and practice IPE to aptly assess the biopsychosocial needs of our patients and appropriately delegate the issues outside of our scope of practice. My encounter with this patient and her other healthcare professionals provides me with hope that our healthcare system is indeed capable of caring for the whole patient under the right paradigm, and I am proud of going into a field where individuals from different healthcare backgrounds also wake up each morning and share my goal of taking care of our patients as best as possible.
- Tricco AC, Antony J, Ivers NM, Ashoor HM, Khan PA, Blondal E, Ghassemi M, MacDonald H, Chen, MH, Ezer, LK and Straus SE. “Effectiveness of quality improvement strategies for coordination of care to reduce use of healthcare services: a systematic review and meta-analsysis”. CMAJ. 2014 Oct 21; 186(15): E568-E578.
- Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI and Bates DW. “Pharmacist participation on physician rounds and adverse drug events in the intensive care unit”. JAMA. 1999 Jul 21;282(3):267-70.
- Chomienne MH, Grenier J, Gaboury I, Hogg W, Ritchie P and Farmanova-Haynes E. “Family doctors and psychologists working together: doctors’ and patients’ perspectives.” J Eval Clin Pract. 2011 Apr;17(2):282-287.
Joseph Liao is a medical student in the class of 2017 at The University of Arizona College of Medicine – Phoenix. He is originally from Queens, NY and attended Pepperdine University where he received a Bachelor of Science in Biology. Liao has a special interest in all things pertaining to medical procedures, perioperative management, and critical care. In his free time, he enjoys working with underprivileged youth, playing sports and instruments, cooking, and traveling.