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Stanford University School of Medicine

Working together in health care: Why it’s hard and what works

_JK_0006A large group of care providers often swirls around each patient. There's a primary doctor and nurses and specialists of all sorts — MDs like radiologists and oncologists — as well as social workers, occupational therapists, pharmacists and more.

Traditionally these care providers work separately, each drawing on his or her own expertise to treat one aspect of the patient. And the patient, in this model, is the subject, the recipient -- not a participant or team member.

Reimagining what many consider a dysfunctional model by shaking up medical education is at the core of the Medicine X | ED conference and was the focus of a Saturday morning session titled "Everyone Included in medical education."

Simply getting people from different professions together isn't enough, according to Reid Blackwelder, MD, a professor of family medicine at East Tennessee State University, who is shown in the photo above. "I found we were doing co-located care. We had different professions in one room, but what we forgot is the need for that communication."

Communication may be the biggest challenge students in the health professions face, said Heather Davidson, PhD, director of program development at the Vanderbilt Program in Interprofessional Learning, which brings together students from different disciplines to learn together. "Learning the science is basically pretty easy," Davidson said. Sure, it takes time and dedication, she admitted. "[But] it's hard learning how to work in teams and with individuals."

Blackwelder and his East Tennessee colleague Brian Cross, PharmD, said they learned that it's important to integrate students from different professions and patients throughout training. They found it worked well to create teams that persisted for several years and tackled challenges together.

"We are bringing together these 17 different [disciplines] and saying 'It's time to work together. It's time to remove siloes of care and siloes of thought,'" Cross told the audience.

They hope this interprofessional approach spreads beyond their campus.

"We are trying to create that model," Blackwelder said. "We want to create a group that is demanding to see this change."

Integrating different professionals is challenging enough. But to bring about real change requires re-envisioning the role of patients. And that is something speaker Sook-Lei Liew, PhD, a neuroscientist and occupational therapist at the University of Southern California, said that occupational therapists have been doing for years. "We can't do a treatment session without asking the patient 'What matters to you?" not 'What is the matter with you?" she said.

But to enable patients to do everyday activities that are important to them, occupational therapists — and other care providers — need to understand what it's like to experience life as the patient, to live with a spinal cord injury or the aftermath of a stroke. Liew and her colleagues are working to develop virtual reality tools to emulate that experience as well as teaching her students to listen to patients' stories.

Why is this culture change so hard, Medicine X founder Larry Chu, MD, a Stanford anesthesiologist, asked the panel of speakers.

"[Currently] the mastery that our learners get is the mastery of a bad system. They learn how to make a bad system work well enough to get through," Blackwelder answered. It's hard enough learning a new profession, even harder to learn how to change it as a new professional.

Another must-have is recognizing that doctors aren't necessarily experts in learning, Cross said. "One of the issues at the center of this is admitting that we need some help from our educational colleagues," he said.

But the panelists expressed optimism about the future. "If we change our thinking, if we change our culture — I really don't think it can be so hard," said e-patient and blogger Andrea Downing. "I think it can be powerful and amazing."

Previously: Medicine X | ED happening this weekend and On learning, the patient's voice and the power of stories: Stanford's Medicine X | ED begins
Photo of Reid Blackwelder courtesy of Stanford Medicine X

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