For Top ACO or Team Care, Check Physician Egos at the Door
"It's a cultural change, it's a huge change," Thayer says, especially for the physicians. "It is a cultural change to accept the notion that you as a physician are not in the center of the care process. It's the patient and everything is being done that is necessary to optimize the patient's well-being."
So, multidisciplinary techniques are definitely part of the framework of care, but ego is part of the potential for disarray.
The physician conflicts that underlie the potential good of multidisciplinary approaches were addressed in a 2009 book by Atul Gawande, "The Checklist Manifesto – How to Get Things Right." Gawande is a physician and writer for The New Yorker.
"We in medicine continue to exist in a system created in the Master Builder era -- a system in which a Lone Master Physician with a prescription pad, an operating room, and a few people to follow his lead, plans and executes the entirety of care for a patient from diagnosis through treatment," Gawande writes.
"We've been slow to adapt to the reality that, for example, a third of patients have at least 10 specialist physicians actively involved in their care by their last year of life and probably a score more persons, ranging from nurse practioners and physician assistants to pharmacists and home medical aids, " Gawande adds. "And the evidence of how slow we've been to adapt is the extraordinarily high rate of which care for patients is duplicated or flawed or completely uncoordinated."
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