For Top ACO or Team Care, Check Physician Egos at the Door

Joe Cantlupe, for HealthLeaders Media , March 24, 2011

 "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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1 comments on "For Top ACO or Team Care, Check Physician Egos at the Door"

pete.kelley (3/25/2011 at 10:45 AM)
As they say, "There is no 'I' in 'Team'." I like the concept. No one in charge and no individual accountability. In the current system, as the attending surgeon, I am considered the 'captain of the ship' and bear full liability for the patient's outcome. During the course of a patient's care, I have to deal with several anesthesiologists, CRA's, circulating nurses, scrub tech's, radiologists, pathologists, and an army of nurses and 'patient care techs' as the shift-workers come and go. I am the only constant in the patient's course of care. I will be happy to check my ego at the door if I can also leave my liability there.




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