Teamwork, page 2
Dr David Williamson is a consultant orthopaedic surgeon at Swindon’s Great Western Hospital. He and colleagues in the trauma and orthopaedic department won Hospital Doctor magazine’s Surgery Team of the Year award for 2006. He is concerned about how changes to medical training and shift patterns may be alienating junior doctors from the team.
“When I started out in medicine, junior doctors were allocated like an apprentice for a period to two or three consultants – who had their own team made up of a registrar, a senior house officer (SHO), housemen and medical students. You don’t have that setup anymore.”
In a truly multidisciplinary team, which sees a range of patients for surgery, the four junior doctors in Dr Williamson’s team work shifts, so often only one can go to theatre or help in clinic. Although he acknowledges the benefits of policies limiting their hours to reduce fatigue, he thinks they miss out on vital experience in theatre, clinics and on the wards.
Originally from South Africa, Dr Dirkie Swinfen most recently practised as a registrar in accident and emergency medicine before applying for GP training. As a trainee in South Africa, she found disharmony between medics and nurses.
“I think it’s because there’s not always that communication open for nurses to doctors. They sometimes feel medical students are sort of below them and they can assert some authority. I think many doctors had the attitude – some still do – that they have superior knowledge and skills to other staff, which can be very dangerous for patient care.”
Dr Swinfen’s view fits with research in USA hospitals, which showed how nurses consider surgeons poor team players and would often be too intimidated to make them aware of a problem or near-miss.
Similarly, a study comparing attitudes about stress and teamwork between hospitals and the airline industry found that only 39% of anaesthesia consultants, 28% of surgical nurses, 25% of anaesthetic nurses and 10% of anaesthesia trainees reported high levels of teamwork with consultant surgeons.2
However, doctors may well be better team players than they are given credit for. Doctors were asked for their views on teamwork and skill-mix in a British Medical Association survey in 2005.3 Only 42% considered doctors – being “the most highly-trained professionals” – as natural leaders of multidisciplinary teams. Moreover, just 24% of doctors thought their traditional responsibilities should not be delegated to other healthcare professionals. It seems that doctors are prepared to accept change and benefit from the chance to concentrate their skills on more serious matters.
“It’s a balance really of non-medical staff doing the things that don’t necessarily have to be done by a doctor. We make sure that junior staff and registrars go with the physiotherapist or podiatrist and see what they do, so they don’t lose out on that aspect of patient care,” says David Williamson.