Comments of physicians and other team members on various issues
| ISSUES | PHYSICIANS’ COMMENTS | OTHER TEAM MEMBERS’ COMMENTS |
|---|---|---|
| Decision making | ||
| • Physician as autonomous decision maker | I’d be trying to get information from everybody … and then I would be making the final decision. (FP #3) | Sometimes you are working in an environment where they [physicians] need to take more of a leadership role, but sometimes on a collaborative team like we’re on now, it can be more of a collaborative effort … But I can also identify certain areas of practice or a consultative role where that decision making I think has to be more immediate. (HCP #2) |
| • Physician as collaborative decision maker | You want to rely on as many people’s opinions as you can. You know they’re spending more time with them [the patients] and often can give you insight. (FP #4) | The inpatient … unit physicians … respected their team members and they were very clear in being able to articulate that they understood they did not hold all the pieces and that different players needed to feed information to them so it was a 2-way street, so that we could all do our jobs more effectively. (HCP #1) |
| Role on the team | ||
| • Physician as leader of the team | There has to be a captain, and … I would like [to] think that, that the physician should be the captain of the team. (FP #3) | But in terms of expectations, the expectation is that when there is a time when the buck has to stop somewhere I want a physician who is clear, definitive, and can really make a definite statement at the end about a recommendation based on the information he’s got from the team, and you don’t always get that, and that is an expectation that I have in the care sector. (HCP #2) |
| • Physician as a member of the team | The other multidisciplinary team I work on has … a nurse who is the program head and then … there’s a kind of a case management approach where I [the physician] am only a member of the team. (FP #1) | I would like them to be an integrated player. Not the parental, patriarchal figure that directs the team. But that we all have input into creating what’s best from a client-centred perspective. (HCP #1) |
| Insider or outsider on the team | ||
| • Physician who is in | You know, I’ll have to sit down with the nurse and the pharmacist and go through [the information]. Is there another choice of medication? (FP #3) | I expect them to be very involved—visiting the patients regularly, attending our conferences, family committees as well as patient conferences. (HCP #2) |
| • Physician who is out | The physician, as part of the team meetings, should have an agenda that’s fairly tight, that runs on time, and in addition, would allow for the physician to have their input, but at an appropriate time the physician could then leave. (FP #3) | They schedule hours to be here when the majority of the team is not here. We can always leave notes or what have you, but there’s nothing like a face-to-face communication, but coming here at 7:00 am they are not likely to run into many team members. (HCP #2) |
| Responsibility | ||
| • Physician has responsibility | It all goes back to the physician … (FP #3) | But nobody ends up having to be [responsible] because I think right now our model is the physician signs the report and they indeed do have the accountability and responsibility of that report. (HCP #1) |
| • Physician shares responsibility | My experience would be a more positive one because I find it very educational to, to be a member of the team. I always find it quite breathtaking, the knowledge that the pharmacist can bring to the team in the meeting … they’re gently educating me into how to treat this patient better. (FP #2) | When you look at the incident following an error and who’s responsible, the top of the line is the pharmacist, then it will be the nurse because she gave it, and then the bottom of the line the physician because he ordered it. You’re supposed to check it, and you’re supposed to check it again. We were taught as a nurse, you handed the pill so you bear the responsibility of was the order correct. (HCP #2) |