FROM SILOS TO SYNERGY
Collaborative Medical Care: A Neurologist’ s Perspective
by Vasudeva Iyer, MD
Every aspect of the art and science of medical practice may be considered a collaborative effort. This can be seen in any medical facility, from the small outpatient clinic to the sprawling metropolitan hospital. While the patient is the nucleus, physicians, nurses and other healthcare workers collaborate to provide the needed comprehensive care. Often, the family physician plays the unique role of the commander-in-chief being responsible for the total care including directing / organizing each specialist’ s evaluation and treatment as needed. Close collaboration between emergency medicine and family medicine specialists is another situation, vital for coordinated management across the acute and long-term settings. 1 Currently, optimal collaboration may be lacking in many circumstances, and the American Medical Association has stressed the need for teaching and training future physicians in collaborative medical care. There has also been a plethora of scientific papers dealing with collaborative holistic medical care focusing upon several aspects including the vital role that the physician should play as the leader of the team. There is even a journal dedicated to disseminating“ interprofessional research in health and social care, encompassing interprofessional education and collaborative practice”( Journal of Interprofessional Care).
When I tried to“ brainstorm” the scope of this article, I was confronted with a bit of a“ brain fog” as only complex scenarios came up as examples of collaboration with my medical colleagues; hence I decided to follow the time-tested path( based on my odyssey as a“ clinical pedagogue”) of using real world clinical examples.
Patient 1: A 20-year-old was frustrated with no improvement from physical therapy after sustaining injury to the right brachial plexus during a motorcycle accident three months earlier. The family got fed up with the same answer from several physicians,“ It will take time; just continue with the exercises.” The physical therapist finally suggested that they see an expert on brachial plexus injury at the highly regarded Kleinert Kutz Hand Care Center in Louisville.
In this context, let me start with one of my initial forays into collaborative medical effort. When I joined the Neurology faculty at the University of Louisville School of Medicine in the 1980s, I was determined to pursue all three goals: teach, do patient care and pursue research. Prof. James Longley, then the Chairman of Department of Anatomy( currently Department of Anatomical Sciences and Neurobiology), a scholar and one of the nicest persons I have ever known, kindly provided me with lab space for research. The crown jewel of the Department of Anatomy was the Fresh Tissue Dissection Laboratory( initiated by the world-renowned Prof. Robert Acland, pioneer of microvascular surgery). 2 There was much demand for fresh cadaver dissection from different specialties, especially the surgeons due to the unique“ tissue feel” during dissection. In that lab, my path crossed that of a young enthusiastic hand surgeon, Dr. Warren Breidenbach( Dr. B), who was keen to improve the outcome of surgery for brachial plexus injury.
Dr. B wanted me to precisely localize the site of injury in his patient with the brachial plexus injury. EMG evaluation showed features of
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