When you're admitted to a hospital, the hope is that you will get better. But according to the Journal of Patient Safety, as many as 440,000 people every year die because of medical errors. That would make medical error the third leading cause of death in the U.S., after heart disease and cancer. These statisitics, combined with incentives under the Affordable Care Act to improve quality, are prompting medical schools to teach students to work in teams. But the new model requires the tearing down of the traditional hierarchy in the world of medical care.
Frank the lobsterman is a mess, health-wise. He's a smoker with respiratory problems. He has chronic back pain. And he has family members who are also in poor health. But Frank has a team of professionals trying to figure out how to get him healthy.
Budding physical therapist Lisa Gerhardt says an occupational therapist could help. "Do a workplace assessment for Frank," she says, "since I think his priority is being back on the lobster boat."
Frank is not a real person, but a fictional patient. And his team of providers are studying the health professions at the University of New England, working to become doctors, dentists, pharmacists and social workers. Thirty teams with about 6-10 students each are simultaneously trying to figure out the best care for Frank.
Pharmacy student Megan Arsenault scrolls through her smartphone to check out drug interactions. "I was just double checking the Xanax," she says. "Yeah - we want to get him off the aspirin."
This exercise is part of a curriculum at UNE called interprofessional education. Basically, it teaches health professional students how to work as a team.
"What we know from the science of team is that team has to be taught," says Dr. Dora Anne Mills, vice president of clinical affairs at UNE. "You know, a team of experts is not an expert team. It is very critical that we teach our students how to be expert teams."
And that's because traditional medical teams tend to have a hierarchy, with the doctor at the top. This new model is more collaborative, more holistic.
So says Dr. Barbara Brandt, the director of the National Center for Interprofessional Practice and Education. Brandt says increasingly, health professionals need to take a big picture look at each patient.
"We now know that much of people's health problems may not be solved by the delivery system," Brandt says.
Health problems, says Brandt, are often rooted in social factors, such as living and working conditions. No one health provider can hold all the answers, and sometimes, the doctor may not be the best person to direct a team. "Some of the challenges of every day life, might be better managed by a social worker," Brandt says.
But to be an effective team, every member has to give input. That's not always easy. UNE, says Brandt, is a national leader in interprofessional education, mixing different health majors into the same classes, swapping out lecture-style seating for round tables, and having students work in teams during clinical rotations.
"I wanted nothing to do with it! I was like, I am here for pharmacy. All I want to do is pharmacy. It's going to be overwhelming," says Dr. Michelle O'Meara, a recent UNE pharmacy grad.
O'Meara says she also found it a bit daunting to cast aside the traditional power hierarchy. "What on earth am I going to contribute that the doc already doesn't know about? What on earth am I going to possibly say? Am I going to look like a giant waste of time?"
And Dr. Michael Light, another recent grad, in osteopathic medicine, also had reservations at first. "I was like, 'Oh - now I've got to see patients with a pharmacist. They're going to slow me down. I'm already slow enough because I'm a third-year med student."
But Light says UNE's team-based curriculum was one of the reasons he picked the school. He saw the team approach as a way to lighten the crazy, lonely hours of a doctor. But when it came time to work with pharmacist Michelle O'Meara in one of his rotations, he says it was an adjustment.
"It's kind of like one of those things where we're taught to be right all the time, but yet we need to ask for help," Light says. "We don't do that well."
But both Light and O'Meara say they slipped into team mode almost immediately. And easily. But Light says many practicing clinicians don't think to consult other health professionals - even in their own office. He remembers another rotation, where he worked with a practicing doctor.
"And the doctor was prescribing meds for this patient whose blood pressure was uncontrolled," he recalls. "The physician kept throwing meds at this patient, and changing them and trying to alter them, and they had a clinical pharmacist on staff two doors down."
And Light says he's learned that relationships with other health professionals actually save time in the long run and, most importantly, improve care. "What I learned is that you can miss a lot. These people are very smart, there's a whole other world out there that we don't learn about."
And O'Meara says the training changed the way she sees herself as a provider. "I feel like I can have that conversation about whether a medication is appropriate for someone. And I feel like my opinion is valued."
An opinion that can potentially change a patient's health care, for the better. Dr. Barbara Brandt says interprofessional education is still in its relative infancy, in about 30 percent of medical schools. But within the next few years, she expects nearly every medical school to have some form of team-based curriculum.
