| Ch 12 | Page 10 / 13 | |
| Multidiscliplinary approach |
Personal dialogue | |
- Certainty of being provided with the best currently available treatment far from academic or specialist disputes,
- Certainty of always benefiting from the presence of a competent carer if needed,
- Mutual trust among carers induces patient trust,
- The patient has one personal physician directly concerned by his/her care and available to discuss/explain treatment modalities and/or difficulties. Known as the “responsible physician” or “referent physician”, he/she is the responsible guarantee of treatment continuity.
- Efficient and considerate help from other specialists,
- Thorough discussion of difficult cases,
- Efficient fight against isolation,
- Efficient fight against ‘burn-out’ by sharing anxieties and difficulties,
- Possibility of transferring the responsibility of a patient to another team physician when it becomes too difficult for the referent physician.
- Such an approach should be well organised in order to be authentic and efficient.
- Weekly or bi-monthly meetings of the 'staff', 'committee' or ‘discussion unit’, with strict timing, defined and accepted by all participants without interruption by outside telephone calls or mobile phones.
- Involving all the specialists concerned by the pathology (clinicians, imaging specialists, pathologists, biologists), open to the general practitioner and other team carers (nurse, technician, psychologist, physiotherapist,...).
- Discussing all medical records, without exception, from the list of patients related to the various consultations and ward tours of each staff member,
- With competent secretarial assistants for collecting and transmitting all the necessary information for a constructive discussion,
- Discussing all of the main treatment steps or those to be considered in the case of relapse,
- Suggesting further clinical examination by a colleague from another speciality to obtain better advice (for instance, gynaecological examination under general anaesthesia, rectal examination for prostate tumour, pharynx examination under general anaesthesia).
- Revising medical records together and preparing syntheses for common publication of results.
- This multidisciplinary approach can be adopted within a specialised hospital or at the town or regional level uniting teams from various health care facilities.
This multidisciplinary approach is the ethical answer to our competence limits. In France, two articles (art. 17 and 34) of the Ethics Code describe the legal need for such medical cooperation, and similar recommendations probably exist throughout the world.
This multidisciplinary discussion is not in contradiction with personal dialogue but is a quality guarantee.
In the 21st century, it now appears unthinkable not to benefit from such multidisciplinary support before decision making. Such a solitary attitude would place any physician in great difficulty in the case of serious grievance on the part of one of his/her patients. The great Medical Pope, only responsible before God, died with the arrival of the new millennium!
An authentic multidisciplinary approach cannot be envisaged without engaging the personal responsibility of a referent physician vis-a-vis the patient and the team.
The patient should be clearly informed that his/her medical record will be discussed by the multidisciplinary team (in a more or less anonymous manner by professionals bound by medical secrecy). In France, the patient’s permission does not require written consent but should be clearly indicated in the medical record.
On the other hand, the therapeutic proposal of the multidisciplinary team should be considered as advice or incitation but in no way as an order.
The advice may prove to be inappropriate for many reasons that the responsible physician should detail in the medical record: non-acceptance of the therapeutic proposition by the patient, contraindications due to social circumstances or other medical problems, poor general status or deterioration since the first consultation, rendering the proposed treatment unrealistic.
In such opposition cases, the physician should clearly justify the deviation from the proposed protocol; otherwise, the patient may consider that he/she has not been provided with the best treatment.
The physician should also inform the patient of the proposed treatment and the reasons for which he/she does not judge it appropriate for the treatment to be applied; the patient should accept such deviations.
He/she should also explain to the multidisciplinary team his/her action in order to improve team dialogue: therapeutic proposal not fully understood by the physician, patient’s real situation different from that previously discussed, specific situation outside the protocol, and so on. Such confident dialogue between the referent physician and the team members, will lead to the elaboration of a more adapted protocol to various patient situations, without compromising treatment quality.
The patient may also refuse the therapeutic proposal for his/her own reasons. After discussion, the physician should respect the patient’s decision and clearly note it in the medical record.
In any case, in order to be truly effective, the multidisciplinary approach needs great clarity among all the actors concerned.
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