In getting the opportunity to write this blog, my brainstorming list of topics started to grow. And so I moved from a café napkin to an actual piece of paper. Possible topics included:
- How can reverse innovation be championed and scaled in global health?
- How can doctor well-being be prioritized from training to practice?
- How can we move from buzzwords to lasting action in comprehensively tackling social determinants of health?
The list continued, and I’m already looking forward to more reflection and writing. For now, though, I keep returning to the old adage: start with your story.
My journey to family medicine is a unique one. I have always been drawn to public and global health and amazing opportunities have allowed me to explore these fields in earnest. However, I was also drawn to the depth and potential inherent in the individual patient-physician relationship. After medical school, I found general surgery to be a field that allowed for the further cultivation of this relationship through the surgical arc of pre-operative optimization, operative intervention, and post-operative care. Getting to do a fellowship in health innovation and patient safety, however, served as an integral pause point to reflect on where I could be most impactful. Thus, I made the decision to pivot from surgery to family medicine for the completion of my medical training, with the intent of merging my commitment to clinical patient care with my non-clinical interests from health systems strengthening to medical education reform. Over the past six months of returning to direct patient care, I’ve learned some key lessons about teamwork and I’m thankful to share them in this venue.
Teams Matter
I get asked a lot whether I miss the operating room, and I think the procedural opportunities inherent in family medicine have limited this greatly. However, when I do get back into the operating room for a cesarean delivery or to assist a rural surgeon, I am immediately reminded of how important a truly well-functioning team is. When they function well, surgical teams highlight several key features from closed loop communication, clear delineation of roles and responsibilities, mutual respect, and ability to quickly adapt to changing situations. Over these past few months at Duke, I have been continually inspired by the diversity of medical teams throughout inpatient and outpatient medicine and how they all have lessons to teach.
Most notably, a clinic team is a mixed group of physicians, nurses, physician assistants, schedulers, social workers, physical therapists, and laboratory and radiology personnel. Some are in direct contact and others are not, but ultimately the goal is that they are all trying to provide comprehensive, patient-centered care. When this happens well and on a consistent basis, it appears that certain key elements are present:
- The foundational logistics of scheduling patients, rooming patients, ordering lab work, placing consults, and doing procedures is well-defined and well-communicated so that providers can focus on direct patient care versus trying to navigate an unclear system.
- There is psychological safety among all team members. Similar to the importance of speaking up in the operating room, all team members feeling empowered to speak up and ask questions and/or highlight a concern in clinic is invaluable. It seems to both be a reflection of how included and respected people feel and positively contribute to the growth of these feelings, as well.
- Provider wellness and patient-centered care are not viewed as mutually exclusive. Rather when all team members are focused on optimizing the provider-patient interaction, providers can be reminded of why they went into medicine to begin with and patients can leave feeling seen, heard, and like their core value/concerns are being addressed.
The challenges in health care are complex but it does not need to be a solo fight. As we move forward into this new year, I hope we all get the opportunity to be part of and contribute meaningfully to many teams. As I keep seeing and being humbled by, all team members can set the tone by making sure we are communicating clearly and listening actively (especially in times of stress), upholding ourselves to the highest expectations, and consistently returning to our core principles to provide the kind of team-based care we would always want for ourselves and our loved ones.
Janaka Lagoo is a second-year resident with the Duke Family Medicine Residency Program. Email janaka.lagoo@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Community and Family Medicine or Duke University.