One Dozen Things
The Health Care Team
Scenario Analysis
This scenario demonstrates that in the U.S. health care system, patient care is a team effort. In addition to the physician, a variety of health care professionals, including nursing staff, social workers, physical therapists, and chaplains, play an active role in patient management.
In this scenario, the doctor proposes adding a beta blocker to the patient’s treatment regimen to get better control of his blood pressure. The patient reacts quite negatively. The nurse interjects that she had gotten some information from the patient regarding side effects from prior treatment with this class of drugs. She suggests that another class of drugs, ACE inhibitors, should be considered instead. The physician excuses herself and asks the nurse to step out of the examination room to confer with her.
At this point, the scenario branches. In the first scenario, the physician is obviously very challenged by the nurse’s suggestion and reacts defensively. She berates the nurse for questioning her in front of a patient and makes it clear that she considers this behavior unacceptable and inappropriate. The nurse reacts with deference but not with a great deal of respect.
In the second scenario, the physician realizes that the nurse has obtained information from the patient that may be of value but may have been uncomfortable for him to discuss directly with the physician, and directly asked the nurse “What’s going on?” The nurse, appreciating that the physician is genuinely soliciting her input and assistance, informs her that the patient experienced erectile dysfunction when taking beta-blockers in the past.
The two scenarios present very different ways that physicians can react to input from other members of the health care team. In the first scenario, the physician cuts off the nurse, disregards the value of any information she may have, and conveys a message that she is not interested in the nurse’s professional input. Based on the nurse’s tone at the end of that scenario, it is likely that the physician will get neither her input nor her respect in the future. Hopefully, the nurse will never let that compromise patient care, but this physician may have destroyed what could have been an effective health care team relationship.
In the second scenario, the physician treats the nurse as a professional colleague, recognizing that she may have obtained important information about this patient that may be of help. She does not see the nurse’s suggestion as a threat to her role as a physician, but rather as a source of additional input to help her make the best decision about this particular patient’s care. It can be expected that after this encounter the nurse will continue to provide valuable information and suggestions to this physician, to the benefit of all involved.
It could be argued that it would have been better if the nurse had not questioned the physician’s drug choice in the patient’s presence. This raises the issue of how the members of the health care team can best interact. There are elements of personal preference, tact, and style that will only come with the experience of dealing with members of the health care team. But as these contrasting scenarios demonstrate, the effort to include professional colleagues and the information and expertise that they can provide is certainly a skill worth developing.
