July 16, 2015

Grey Lines – Stepping Over the Interdisciplinary Boundary in Healthcare Education

By Andrew M. Harrison

By Thomas Mork

I was sitting in Phillips Hall in the Siebens Building at Mayo Clinic, immersed in a speech by “Bob”: former patient, cancer survivor, and nationally-renowned speaker. He stood proudly at the podium while his voice reverberated among a crowd of physicians, nurses, and physical therapy students. This self-described “active patient” defied cancer by becoming a dynamic advocate for himself during his medical care. As his story goes, he brought forward multiple treatment options that his physician never considered. They decided to try these treatments when standard care was failing. Over a year later he is still cancer free and advocating to people across the nation to become active members of their healthcare team. The ideas he brought forth saved his life and illustrated that we require contributions from everyone, patient included, within the healthcare system to provide the best care.

Some physicians and therapists might say Bob crossed the line that divides patient from caregiver. They might say that he had no place telling the physician what kind of treatment he should be given. However, this was exactly his point. We can’t possibly know everything about a patient and if a patient is willing to become involved in his or her care to the point of suggesting treatment ideas, this can only help us. The same goes for interdisciplinary teamwork in the healthcare setting. If we are to fight for Bob’s life we need collaboration, cohesiveness, and cooperation among our respective fields, patient included. We need physical therapists notifying physicians they need help managing spasticity. We need speech therapists helping physical therapists include cognitive training during balance exercises. We must remind ourselves that the lines that divide our professions are not black and thin, but grey and wide. The real world of healthcare is fluidly moving over and beyond these lines to enhance our interdisciplinary teamwork. We must complement the strengths and weaknesses of one another to unravel the complexities of the human body with respect to each individual patient. The Mayo School of Health Sciences teaches us just where that grey line is and how to cross it to contribute to the interdisciplinary team.

I remember learning this lesson during a case study session with the Mayo Medical School students. We were each given a practice case and paired up with a medical student. My patient was an older, obese adult who presented with severe abdominal pain and low back pain. Our goal was to brainstorm possible diagnoses and then create a presentation highlighting best care protocols. I blindly took the reins for the assignment and tried my hand at diagnosing what might be going on medically with his abdominal pain. First, my medical student partner in arms let me exhaust the obvious differentials (abdominal aortic aneurysm, appendicitis, belly-ache, etc.) and then she went on to name twenty more diagnoses, only some of which I recognized. When I spewed out some recommendations for medication, she politely pointed out certain side-effects and drug-drug interactions that would make my combinations useless or dangerous. I realized that stepping back to listen to her knowledge in this area would be the quickest path to a solution. Then we came to the treatment session for low back pain. I listened as she listed off pain medications, but jumped in when she said “conservative management”. I taught her the muscles we would be selectively strengthening, those that we would be selectively lengthening, and those that we would reeducate in order to achieve long-term relief. Our teamwork evolved into a comprehensive presentation that left our imaginary patient in a much better place.

Interaction with medical students is just one way that the Mayo School of Health Sciences (MSHS) teaches us to toe the grey line as we learn to communicate with other disciplines. In fact, not a day goes by when I have not had interaction with some other healthcare professional. One day it might be a knee surgeon who recounts a play-by-play of his or her typical cases. Another day it might be a nurse from the ICU who tries to make sense of numerous lines sprouting from a patient’s body. We might be studying in Venables Health Sciences Library in the Siebens Building and overhearing the radiology students talking about MRI proton spin or X-ray magnification. Thus, we are constantly submersed in a diverse healthcare environment – a place in which we are learning from other clinicians, picking experts’ brains for hidden knowledge, and interacting with students of other professions. Our program in the MSHS teaches interdisciplinary teamwork by continuously surrounding us with experts from various fields and students who are experts in areas we barely touch upon. Therefore, when it comes to working in the real world, we already know that we must rely on our partners in the healthcare world to fill the gaps of our knowledge, so together we can provide the best care for our patient. And we want patients like Bob to push our knowledge just a little bit farther.

I began my clinical education in my second year of physical therapy school and instantly found that I was not alone. The occupational therapists in the neighboring gym treated the same patients as me, the nurses reported lab values to our team, and the physicians created their medication cocktails in response to our objective data. I was engulfed once more in a melting pot of different professions in which the goal was to return a patient to their normal life. But this time I was prepared to step across the grey line and fill the void where physical therapy should be. Together we created a plan that we could proudly call “best care”. MSHS prepared us for this moment by surrounding us with the resources and means to communicate with other clinicians in a team learning environment. Its healthcare program entrenches its students in an interdisciplinary educational environment in an effort to expedite the process of working together for the good of the patient. I believe this is the best way to prepare students for a real world – a world in which we must rely on one another to care for others.

Thomas MorkThomas Mork in 2013 at Fort Sumter in Charleston, SC

Thomas Mork was born and raised in North Branch, MN. He graduated from St. Olaf College with a BA in Biology and is currently in the third and final year of the Doctor of Physical Therapy program in the Mayo School of Health Sciences.

Acknowledgement: My sincere appreciation to the Mayo School of Health Sciences for their formal education and in preparing me to be the best clinician I can be.

Editorial comment (Andrew M. Harrison): The entire blog team and the Office for Diversity are grateful for this first-ever post from a MSHS student. We challenge students in the other 40+ MSHS programs, as well as medical residents and fellows in the Mayo School of Graduate Medical Education, to tell your diverse story and why your training program is important for patient care.

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