We work with a lot of colleagues on medical collaboration -- so we see the good, the bad, and the ugly. We help individual providers get set up with iClickCare; help hospitals learn to do medical collaboration; and guide practices in incorporating telemedicine.
And we've noticed extreme variation in which providers tend to do medical collaboration easily and effectively. Of course, our propensity for collaboration varies widely from one individual to another, very much not constrained by job title. But some provider types tend to embrace collaboration more than others.
So, a question for you: which type of provider do you think does medical collaboration best: the nurse, the aide, the patient, the family, the generalist, the specialist, the dentist, the allied health (PT, OT, counselor)?
You can consider the question from a personality standpoint, but don't forget that there are other influences, beyond the individual, which affect our ability to work together. The range of structural influences impact our ability to collaborate at a fundamental level: the insurance company, the managed care providers, the megalith healthcare system, the smaller hospital, the critical access hospital, the health department, the federal government, the VA, the legal system.
All of that said, we've noticed a very consistent answer to the "best" and the "worst" of how providers do medical collaboration: doctors tend to collaborate the worst and nurses tend to collaborate the best.
So why do nurses tend to embrace collaboration and physicians tend not to, at least at the beginning?
Well, nurses are often more collaborative by nature. Many nurses chose the profession because their personalities are supportive and nurturing. By day to day, minute to minute work, they get orders, execute orders and communicate orders. They are the people who get things done. They see collaboration as benefiting them because they can coordinate the many people involved in getting done what the patient needs done. They are salaried and held to production metrics, but less so than similarly salaried physicians. They are constricted by the same forces as physicians such as HIPAA, but by and large are free of contracts with insurance companies, managed care, and productivity reports. Their education reflects these factors.
I also reflect on the dynamic of differing medical education, in terms of the messages we receive around medical collaboration. Since doctors write orders, they are told that they “are captain of the ship” and therefore fully responsible for outcomes even if they are not directly involved in an action. With deeper pockets than nurses, and with this identification as “captain”, it is they who are the targets of the legal system.
The education of physician reinforces the mantle of responsibility. Most likely, the individual physician was taught on the first day of medical school, “Pay attention, learn everything, because the life of the patient is fully and solely in your hands. If the patient dies, it is your fault.”
That is a different role than advocacy that is often taught to nurses. “You are the keeper of the patient. You must advocate for the patient.”
So with doctors and nurses coming from such different starting points, think about the complexity that compounds as we add dozens of different types of providers to the mix -- and we expect them to collaborate on behalf of the patient. I look forward to hearing your stories and experiences of collaboration in the comments below -- every person, case, patient, and provider is certainly different.
As we work together, we need to remember that “none of us is as smart as all of us.”
What if that were the first sentence we learned in medical school, or nursing school, or any professional school? What if it were then reinforced as we learn and work? We would all be happier - and healthier - for it.
Read our Quick Guide to Medical Collaboration here, with stories of medical collaboration from around the world: