We talk a lot about health care teams. The Pennsylvania Medical Society (PAMED) supports the team concept. PAMED opposes the independent practice of advanced practice nurses, not because we don’t respect their skills and abilities, but because we think good medical practice requires a team working together, not separately, to achieve a common goal.
Taking care of patients has gotten too complicated to do alone. People are chosen to be part of a team because they bring their skills, training, and experience to the team to provide care in the most practical, effective, and efficient way possible.
The evolution of our health care team
The days of the physician taking all the responsibility for providing care of every patient they see are gone. A medical practice was unique in that the key member of the practice, the physician, was also the major provider of care – and the front line of that service. Absent the physician, the practice couldn’t do what it was supposed to do.
As practice has evolved, the more routine, simpler tasks can and should be given to others who can do those tasks. No longer does the physician collect the fee from the patient at the end of the visit. Checking the blood pressure, weighing the patient, giving shots, and doing routine vital signs were assigned as tasks to nurses, and then to trained medical assistants.
Seeing the repetitive and routine visits, physicals, coughs, colds, aches, and pain, and the care of basic chronic diseases (as a primary care example) can now be handed over to physician assistants and nurse practitioners. They can now be the front line, with the advanced skill, training, and abilities of the physician reserved for the more complicated patient who requires that advanced ability.
The skills of the physician will slowly and inexorably be reserved only for the complicated and difficult patient, where the many years of additional training of the physician will be brought to bear. This change should be welcomed by most physicians as the most appropriate use of their skills and training.
But not all physicians welcome this change. They are oriented differently, and choose not to team up to provide care, but to provide it “the old fashioned way,” one patient at a time seeing the physicians for their issues.
Telemedicine adds another dimension
The increasing ability to remotely monitor and interact through telemedicine technology brings a whole new dimension to the team concept. We don’t have to be in the same building, or even in the same country to assist another member of the team to take care of patients.
Our teams must be interactive, tied together so that resources are immediately available when the simple turns out not to be, and the frequency of the need for that interaction must dictate the closeness of the ties between the members of the team.
Let’s work together as a team, to build a better care system, not try to fragment the care further. Are you part of a high functioning team?