In theory, none of us SHOULD need to do medical collaboration. In an ideal world, each healthcare provider has perfect knowledge of every disease and impeccably up-to-date information on their patient, at all times.
The reality? Each healthcare provider has a rich, powerful, and incomplete perspective. That means that the super-specialist and the aide both have a crucial role to play. And that the more we communicate with each other about our patients, the more fully we can help them.
It’s not often you have precise confirmation of this reality. But a recent article in JAMA put a spotlight on it for me.
One of the more routine things we do as doctors is recommend cancer screenings. It’s not the most sophisticated analysis; it’s not the most intense moment. But it is important and absolutely does save lives.
As routine as this may be, however, it is still powerfully impacted by the real limitations we have as busy, human people who are acting within a context of too-short visits and too-hectic care contexts. In fact, this recent study by the University of Pennsylvania, and published by JAMA, shows that "As the overall clinic day progresses, clinicians may face decision fatigue, defined as the depletion of self-control and active initiative that results from the cumulative burden of decision making"' and that "Relative to 8 am, the adjusted odds ratios (OR) of clinician ordering and patient completion of breast cancer screening was significantly lower for each hour from 10 am to 5 pm."
In other words, even the most fundamental aspects of the care we provide are impacted by our own energy levels and the context in which we see the patient.
This isn't shocking; it is completely natural and human. But — it’s our responsibility to support ourselves so that every patient we see gets the same standard of care. Just as it is our responsibility to wash our hands, it is our responsibility to get the collaboration and support we need from colleagues through telemedicine-based medical collaboration. We can't fix the healthcare system. But we can make sure that we have the tools we need to work effectively within it — every hour of the day.
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