Interprofessional relations between a patient and the healthcare practitioners Introduction

Teamwork is a vital skill for health care professionals, but the fragmented systems within which they work frequently do not recognize nor support good teamwork⁽¹⁾. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved⁽²⁾.  The objective of this project is to analyse the challenges healthcare professionals  face within their working environment. In this, by relating the roles of physicians, pharmacists, physiotherapist,  and nurses face in this juridiction. Finally we must come up with  solutions that could guide the future of healthcare professionals aiming to give better quality of health care system to patients.A caste study will be used in the presentation on COPD to demonstrate our findings.

Barriers to Interproessional Healthcare

Some of the common barriers to interprofessional healthcare will include; inadequate communication, lack of knowledge and appreciation of the roles of other health professionals. This further includes lack of training in interprofessional collaboration,regulatory constraints, hierarchical administrative and educational structures that discourage interprofessional collaboration⁽³⁾⁽⁴⁾.

Challenges within the Interprofessional Teams

Interprofessionalism is particularly important and challenging in the healthcare industry, where many health professionals practice and learn together where team membership changes frequently⁽⁵⁾.  While working in a healthcare environment it is extremely important that all healthcare professionals work together in an efficient manor to achieve their goal. Although this sounds like a simple task it is a subject matter, which poses a real challenge to physicians.

Interprofessional collaboration is mainly dependent on communication. The issue of collaboration between health professionals has been a great challenge in today’s society. Inadequate communication mechanisms will compromise teamwork efficiency. One key factor that would hinder optimal communication is insufficient adoption of a formal mode of communication between team members. Informal ways of communication are not enough for optimum health care. In this field, some workers intentionally decide to work on their own to achieve the same goal that could be better achieved by need teamwork. This is usually not achieved as the patient will never be treated by one particular healthcare professional⁽⁶⁾. Difficulties in collaborative teaming is believed to be due to the lack of training in different roles of healthcare professions in a patient care. This form of education is intended not only to sharpen skills or keep up with the new advances in the industry, but also to educate the importance in gaining understanding and respect for others⁽⁷⁾.

Team members may all come from different backgrounds, along with specific knowledge and skills, thus it is important for them to develop a deep understanding in terms of their inter-disciplinary roles in accomplishing a mutual task. The self-awareness plays a big part in which the lack of commitment or contribution of one could eventually dysfunction the entire team. As a consequence, it might lead to failure upon collaboration in inter-professional health care system and hence unable to provide good quality of service to patients.

The issue of time pressure within doctors and other healthcare professionals involves distractions in the environment. This can contribute to poor communication in complex working environments⁽⁸⁾. Communication is a huge probem in interprofessional development. Physicians and pharmacists face similar barriers when it comes to prescription writing. The physician might write a prescription that is not clear enough about the strength and dose of  a medication especially drugs that have narrow therapeutic index. For instance  dixocin and warfarin both have very small dosing changes that could have a severe impact for the patient outcome hence a small mistake could be fatal. When the pharmacist receives a prescription and is in doubt then he or she should check in the Summary Product Characteristics for the therapeutic dose. If he or she is still not sure it is crucial to communicate with the doctor about the strength of the medication bearing in mind the safety of the patient.

One reality case witnessed by one of our group members was when a lady entered the pharmacy with a prescription for Spiriva and Ventolin for herself, for the treatment of Chronic Obstructive Pulmonary Disease. The dose on the prescription was not clear and the pharmacist planned to contact the prescriber to confirm the dose and dosage frequency. In the meantime, the pharmacist still double-checked the dose  with the available reference sources (British National Formular, Summary of Product Characteristics). There has been communication barriers where it becomes difficult to contact the doctor on duty who wrote the prescription. In many cases, this could take up to 24 hours when the patient is due to start the drug immediately. Additionally there are scattered patients, fragmented information, uncoordinated teams, and unreliable processes that can impact the timeliness, safety  and care of the patient.

Teamwork in primary health care setting in particular involves considerable overlap in competencies. Another common barrier to interprofessional teamwork is the problem of “turf battles.” These struggles overprotecting the scope and authority of a profession. It also  involves issues of autonomy, accountability, and identity⁽⁹⁾.Therefore healthcare professionals need to have a formal approach when in a work environment, especially when interacting with colleagues and superiors, and sharing information with relevant parties. In order to increase the efficiency of teamwork, an adoption of formal communication methods needs to be implemented⁽¹⁰⁾. Formal methods include frequent recorded meetings, and assigning specific tasks for group members to carry out throughout procedures. Other formal mechanisms that are of benefit are “inter-professional case conferences”, where a group of healthcare professionals  collaborate in solving difficult cases⁽¹¹⁾.

The role each physician differs and it is important that all health professionals understand and appreciate these roles. Often one physician may feel he/she should have a greater amount of power than another physician and this leads to conflict therefore leading to consequences for the patient⁽¹²⁾. It is clear that each physician has a specialty. For example in COPD the doctor will diagnose the patient, the physiotherapist may provide exercises to help the patient and rehabilitation programmes and the pharmacist will provide the drugs for the patient. Although all of these tasks are separate, it is evident that all the information will need to be linked together in order to help the patient⁽¹³⁾. If one physician feels they should have more power then the link between these professionals will be broken. Sharing this power may be difficult as as physicians each individual has been taught to be a leader and take responsibility although in a hospital environment the power must be distributed correctly in order to benefit the patient. Dismissing the roles and ideas of others within the healthcare profession will cause conflict and rivalry^(13)(14). This rivalry often comes between the patient and the physicians as the competiveness between the professionals often distracts them from the patient, therefore missing vital information and this could lead to serious consequences ^(3)(15).

Conclusion

In conclusion, underestimating  the challenges within the interprofessional team may lead to insurmountable problems when it comes to curing the patients. Therefore, the main focus for each physician should be the patients, the best healing path and ending up with the least drawbacks possible. Overcoming interprofessional challenges might not be as simple as we reckon but there is always a solution for each problem faced by the interprofessional members. Such solutions could be; good formal communicaion skills within the interprofessional staff, respecting the role of each physician and having a good time management. Due to fragmented information and uncoordinated teams within interprofessionalism, a proper Standard Operating Procedure in place could help minimise a lot of these interprofessional issues. In this staff may refer to it at any time when in need. All of these simple solutions may lead to the pateint’s benefit.