MedicoPlexus
Medical Psychology and Sociology
William Peach
The Concept of the “Medical Team”, Communication and Doctor – Patient Interaction
Healthcare models, like many other organisations, must be multidisciplinary in order to be fully effective. Teams are at the core of quality delivery. They also reach their highest levels when communication between members at all levels is streamlined and well ordered.
Problems relating to psychology and psychiatry, are, as in most specialties of medicine, often complex and difficult to solve. Practitioners working on the frontlines, solving, researching and delivering care on a range of mental issues, certainly have a broad spectrum of responsibility. Medical teams, as this paper suggests, help busy professionals come together to share that weight, sharpening and improving our overall approach to mental health worldwide.
Exploring how specific teams operate in the field of psychology, their methods of communication and how these factor into the delivery of effective care for the patient is the main scope of this paper. On a superficial level it’s worth exploring how useful these approaches are. At a deeper level; we might ask the question; is there anything that can be improved upon?
The Concept of the Medical Team
Boston University’s Professor of Community Health Science’s Joan Bragar defines a team as “a group of individuals who work together to produce products or deliver services for which they are mutually accountable.” On the surface, this is as true in health science as it is in business. Each part of the team works together as an accountable whole with a common goal in mind.
Historically the concept of a team is as old as humanity itself. Evolutionary psychologists point to prehistoric man’s struggle for resources as a reason for forming mutually interested parties working together to eat, build and survive. Psychological theory is no stranger to the concept either, with entire libraries of dedicated analysis based on questions relating to the collective and the individual.
For the sake of this paper, I’ll skim over the contrivances of the collective and the self in the field of psychology. But in order to distinguish the “team” from the “collective”, it is also worth mentioning that psychologists consider them both different concepts. In hopes of discussing benefits, drawbacks and the like of a team – as well as for the sake of brevity – this paper will attempt to avoid wandering into that particular debate.
Medical teams then, just like teams across the spectrum, are comprised of a group of individuals with distinct and defined roles. Where they differ? The field of operation.
Whether it’s a busy city hospital or a small rural clinic, the site of operation for medical teams is markedly broad. Operating on both local and international levels, such teams can often be stripped down in scope or taken as a sample of a larger whole. Renowned operations like Doctors Without Borders (Medecins Sans Frontieres), for example, operate globally as a 30,000 strong collective with individual teams providing care and aid in areas as diverse as Cambodia, Libya, Sierra Leone and Sri Lanka. Some teams in remote enclaves of the world, on the other hand, might be as small as two or more people.
Finally, an important point to help solidify our understanding of a medical team is that of the word “synergy”. Academic Jain Naresh, in his essay Run Marathons, Not Sprints , mentions the importance of this in his assertion that “team members need to learn to help one another, help other team members reach their true potential, and create an environment that allows everyone to go beyond their limitations.” It’s this demarcation that separates the concept of team best from that of the group.
The Medical Team in a Psychology Setting
Shifting focus to the concept of a medical team in a psychological or psychiatric based setting, it’s important to get an idea of how teams in this space might operate. According to Rethink Mental Illness, a leading charity provider of mental health services in England, the goal of teams in this field should be to “serve people living in communities who have complex or serious mental health problems”.
Rethink Mental Illness itself also provides a strong example of what to expect from a medical team dealing with such issues. Core to its philosophy is bringing professionals together from “different health and social care backgrounds” in positions that might include psychiatrists, psychologists, social workers, occupational therapists and community psychiatric nurses. Diversity, it seems, is something that programs like this place great emphasis on in the provision of high quality mental health services.
Interestingly this ethos of medical teams in mental health is a relatively new one historically.
Tyrer, Coid and Simmons’ paper on Community Health Teams (CMHTs) underlines this change when they discuss the shift from centralised treatment within the asylums of old to a new and more humane “community approach”. Partly driven by convenience, government policy and cuts in funding, the validity or effectiveness of this shift is still open to question.
Outside of American and European attitudes toward mental health-focused medical teams, we can also see a general trend among other nations to put greater emphasis on tackling such problems. The WHO’s establishment of a global Mental Health Day based in October, is a positive step forward in helping to raise awareness worldwide of problems as complex as depression and suicidal ideation.
Despite these trends however the statistics are quite brutal. Every 40 seconds someone loses their life to suicide and suicide still remains the number one cause of death in men under 40 in most of the developed world. Mental health teams operating in the face of such data then? Arguably still have a lot left to do.
The Benefits and Drawbacks of a Team Based Model
One reason for the existence of medical teams is explained by academics in Advances in Patient Safety. According to their study, which studies medical teams in the US and beyond, teamwork not only “plays an important role in ensuring patient safety” but also “minimises the mistakes of individuals”.
Despite these assertions, however, these same academics also support the need for evidence when it comes to tracking the effectiveness of medical teams. “Simply installing a team structure does not automatically ensure it will operate effectively” they warn, nor is it an “automatic consequence of placing people together in the same room.”
The big picture then is relatively consistent across the board. Healthcare systems value teams as safer environments to provide care, share the responsibility among individuals and help raise the overall quality of decisions made. The natural consequence of all this is bolstered by the data and most nations’ health sectors adopting similar team-based approaches.
But where the benefits of team based models are clear the drawbacks are just as visible. The amount of academic research geared towards their measurement attests as such. Drill down to the service provision level and the output of the team is exceedingly difficult to measure given the many working parts.
Outside of that other problems are present too. Issues pertaining to cost and training are two big factors that take away from service provision at an individual level. So too do complexities arising from team dynamics, working environments, measurement criteria and everything else involved in a system founded on varying personalities, cultural backgrounds and educational levels.
For all the effectiveness of medical teams, it seems, comes a whole range of complications too.
Communication Across Healthcare Teams
One essential for a medical team to capitalise on the benefits of its system is the role of communication. Without effective channels to guide, lead, organise and support the people involved, a team soon falls apart and ceases to function.
How then do healthcare teams most commonly communicate? The answer resides somewhere in the study of the team itself, with smaller organisations obviously better equipped to streamline the process given the advantage of dealing with fewer individuals.
But where communication within teams themselves, with channels like email, phone, video and written manuals and protocols, is obviously important, so is their output in terms of how they deal with patients. Effective communication on this front, it appears, is all about engagement.
“A key aspect in improving teamwork and communication in healthcare is engaging patients and families…determining how they want to be involved in their care and engaging them in designing their plan of care,” writes Jay Bhatt, President and CEO of Health Research and Educational Trust. For this reason, communication must be very carefully considered.
Communication in a Psychology Setting
Perhaps communication in mental health teams, given the nature of the pathologies they deal with, is more important than that of other specialisms. Dealing with symptoms that aren’t initially obvious, hidden and complex, means that team members rely heavily on nuance, skill and inference rather than scans, physicals and blood work.
Front line workers in mental health then need to be highly effective communicators to operate both in teams and with the patient. Achieving this goal is strongly dependent on successful training but is arguably worth the expenditure and risk. As Strensrund asserts in Mental Health Family Medicine, the outcome of such renewed focus results in “higher patient satisfaction, better patient adherence and symptom resolution.”
Benefits and Drawbacks of Current Communication Methods
Current communication methods, as previously ventured into with the mention of initiatives like Rethink Mental Illness and World Mental Health Day , rely on raising public awareness around an area of medicine that has largely been ignored.
The pressures of readjusting our focus are clearly numerous, with demands for funding and the intricacies of delivering a message to an unsuspecting audience clear challenges.
But where difficulties exist there is also hope. Renewed efforts from organisations like WHO and governmental institutions to shed light on mental health issues, as well as the formation of Community Mental Health Teams around Europe, the US and beyond, do a lot to pressure resistant authorities into taking action.
New initiatives like those of Foundation d”Harcourt operating in places like Togo, serve as examples of many countries taking new strides into solving their populations’ mental health issues at a grassroots level. High profile people too, as exemplified by Prince Harry and Meghan Markle’s adoption of a recent Canadian mental health awareness campaign, aptly do their bit to bolster the work of teams around the world.
Doctor – Patient Interaction in Psychology
Potentially an even more important conversation necessary to be had around the subject of team communication in mental health, is that of the doctor-patient dichotomy. Without skilled doctors at hand, diagnosis and treatment plans – for all the help of a support team – becomes all the more difficult.
Obviously this issue has solutions with the restructuring of mental health teams and granted powers of nurses and other mental health professionals to prescribe, diagnose and offer first-hand support. The question remains however, as to whether this is a sensible approach. The data is simply not old enough yet to attest to the success of such changes.
Traditionally then, as in most of the world, responsibility still falls on the doctor to provide primary care. To do this effectively they arguably need have a strong tool-set of empathy, understanding, experience and patience. As well as the ability to listen well and ask the right questions.
Problems and Solutions in Doctor Patient Relationships
Being an effective doctor in this space then, as previously argued, demands a lot from a professional. Training protocols, staggered throughout the course of years, putting strong emphasis on exposure to both common and rare cases, is an absolute necessity. Any teams that help foster this environment, helping minimise administrative, logistical or non-urgent support, are essential to successful training.
The implementation of a system like this no doubt brings a great deal of challenge to budget and resource-stretched healthcare bodies. Looking past the stigma associated with mental health issues however, as we have seen with the aforementioned cases of raised public consciousness, is a positive step in the right direction.
References
Saheed H. Wahass, The Role of Psychologists in Health Care Delivery, J Family Community Med, Aug 2005. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410123 /
Bragar, Sarah, What is a Team? Boston University. http://sphweb.bumc.bu.edu/otlt/MPH-Modules/Teams/
Doctors Without Borders (Medecins Sans Frontieres).
Jain Naresh, Run Marathons Not Sprints, 97 Things Every Project Manager Should Know, Barbee Davis, O’Reilly Media, August 2009.
Rethink Mental Illness, England.
P. Tyrer, J. Coid, S. Simmonds, P. Joseph. Community Mental Health Teams for People with Severe Mental Illnesses and Disordered Personality. Cochrane Database, 2007.
https://www.ncbi.nlm.nih.gov/pubmed/10796336
World Health Organisation, World Mental Health Day, 2019. https://www.who.int/news-room/events/detail/2019/10/10/default-calendar/world-mental-health-d ay-2019-focus-on-suicide-prevention
David Baker, Sigrid Gustafson et al. Medical Teams Training in Healthcare, Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools and Products).
https://www.ncbi.nlm.nih.gov/books/NBK20580/
Jay Bhatt, Focusing on Teamwork and Communication to Improve Patient Safety, March 17, 2015.
https://www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-pat ient-safety
Tonje L. Strensrud, Communication and Mental Health in General Practice, Mental Health Family Medicine, September, 2012.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622912/
New Mental Health Initiative in Togo, Foundation D’Harcourt.
Prince Harry and Meghan Markle Promote a Mental Health Initiative Run by a Canadian Mobile
Phone Network on Instagram. https://www.dailymail.co.uk/femail/article-794364 9
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