Three spine surgeons weigh in on the importance of multidisciplinary teamwork and discuss how best to cultivate it.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, March 6, at 5 p.m. CST.
Question: What are some of your best strategies for fostering multidisciplinary teamwork?
Srdjan Mirkovic, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute (Evanston, Ill.): For a multidisciplinary team to work together, all spine specialists need to take a global view when diagnosing and treating a patient. In order to collectively collaborate, each specialist — surgery, pain management, rehabilitation — needs to see the pain and injury in each patient through the eyes of their colleagues. For example, a surgeon looks for the bull's eye, identifying the primary pain generator through tools like an MRI and resolves the problem operatively or nonoperatively. A rehabilitation specialist might immediately suggest physical therapy to see if pain subsides, or a pain management specialist might administer an injection — both after an exam of the patient and viewing their X-rays. Greater understanding of these different approaches should start in training.
Right now, pain management fellowships fail to include time with surgeons. This is a missed opportunity! Furthermore, studies show spine surgery can have better outcomes and be more cost effective than pre-operative treatments in the overall care of the patient. When a group of spine specialists establishes, buys into and follows an algorithm in approaching each patient, true multidisciplinary teamwork is realized.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: This is straightforward. Communication with your referring doctors, keeping them in the loop, communicating with the hospitalist team, as well as other members of the team, such as physical therapy, occupational therapy and speech therapy. Be available to discuss patients if even for two minutes. It makes you look good, and the patient feels comfortable knowing everyone is on the same page.
Joseph Alleva, MD. Division Head of Physical Medicine and Rehabilitation at NorthShore University HealthSystem's Neurological Institute (Glenview, Ill.): A good start is to have an established, award-winning EMR and a standardized approach. Sharing information quickly through the EMR and having a set algorithm for each spine condition builds teamwork across all spine disciplines. An added advantage is to work side by side with the various specialties, like we do at the NorthShore Spine Center.
With 'curbside consulting,' nonsurgical specialists and surgeons call upon each other to discuss a diagnosis and the best treatment, including alternative measures like acupuncture. We take a holistic approach. The proximity and close communication among a multidisciplinary team results in a seamless patient experience. When this breadth of options is available, patients don't have to go off-site to see other specialists. It also enables greater efficiencies among clinicians when all spine specialists are in one place. It creates an environment where multidisciplinary teamwork can thrive.