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Multidisciplinary or interdisciplinary?

I was at the outpatient clinic again last week, meeting another doctor for the first time in search for better explanations for my diagnosis and perhaps better care plans. The visit and the doctor turned out to be better than what I expected, in fact, it went well above and beyond my expectations. The doctor explained to me issues that I should be concerned about and together we discussed the best way to move forward. Apart from that, one thing that really stood out from the visit was her insistence that my case is treated seriously by asking all the subspecialties involved in my care to come together for a thorough discussion so that a better diagnosis can be secured and a better approach to manage my risks can be achieved. To be honest with you, I’ve thought about it too. Perhaps more times than I care to admit.

Let’s get you up to speed. At this point in time, there are seven (7) subspecialties involved in my care. Although most of them are in the same hospital, none has volunteered to play the role of the primary speciality coordinating the process across all the subspecialties. Each subspeciality has its own views of what is going on and how best to treat me. Often the care decisions are made without consulting the other subspecialties. I am concerned that I’ll fall victim to each subspecialty’s tunnel-vision at some point in my care. On many occasions, I worry that there is an elusive diagnosis lurking around the corner that all the subspecialties are missing for having focus too much on what is only relevant to their respective subspecialties. More importantly, what that’ll do to my prognosis has been making me feel rather unsettled.

Although I instinctively knew that the coming together of all the subspecialties would help me a great deal prognostically, I couldn’t stop myself from reading and looking for evidence that either support or negate it. What I encounter is a massive amount of research looking into the role and benefits of what is termed a multidisciplinary approach. But, I also encounter many papers that mention the term interdisciplinary approach. I remember the doctor in the clinic always referring to the act of all subspecialties coming together to discuss patients care plan as a multidisciplinary team (MDT) meeting. I’ve hardly ever heard this other term – interdisciplinary. So what are the differences between them? And are the differences great enough that the distinction between the two should be made clearer in communications with patients?

What is a multidisciplinary approach?

A multidisciplinary approach involves team members with different expertise working on their own towards creating care plans that are applied to patients within a specific discipline. For example, a patient who is about to be discharged home from the Neurology Ward after a stroke may be treated through a multidisciplinary approach by having doctors, nurses, pharmacists, physiotherapists and occupational therapists (among others) working independently to help the patient cope with the illness and improve neurologically from that point onwards. There is much research that have successfully proven that a multidisciplinary approach to patient care improves patient outcomes, mainly due to its patient-centred nature. Some even proved that it also increases team members satisfaction at work.

The approach is appropriate for patients who have illnesses that are limited to single disciplines or patients who have illnesses crossing the boundary of many disciplines but require in-depth care for any of the disciplines. Technically the term covers almost all patients in the healthcare settings, be it, inpatient or outpatient. Even a ‘simple’ diabetic patient requires referral to nutritionists at the very least, and almost every patient will require the expertise of pharmacists at the end of almost every follow-up consultations. So, if nearly every patient requires a multidisciplinary approach to their care, what is the value in even mentioning it? Wouldn’t it be better to automatically associate patient care as multidisciplinary care? After all, that is what we have been doing all this while. And it is quite different from an interdisciplinary approach.

What is an interdisciplinary approach?

An interdisciplinary approach is where team members from different disciplines work collaboratively towards caring for a common patient to achieve a common goal by creating a customised and integrative care plan for the patient. Based on this definition, clearly only patients who have illnesses which span over more than one clinical discipline may benefit from such an approach. Using the same patient who suffered from a stroke in the example before, notice how he/ she may also be treated through an interdisciplinary approach if he/she requires the clinical expertise from other disciplines, say Endocrinology (if the patient happens to be diabetic too) or Orthopaedic (if the patient had suffered from a fracture as a result of a fall due to the stroke). It is not uncommon to see a patient requiring both multidisciplinary and interdisciplinary care.

Patients treated through an interdisciplinary approach have better outcomes as opposed to those who need it but don’t receive it. The approach offers patients and their care providers a platform to see the bigger picture, beyond the silos of each discipline or subspecialties. The integrated approach may also help reduce redundancy in delivering patient care (which happens more often than we realised) and as a result improve the efficiency and effectiveness of healthcare resources. Crucially, an interdisciplinary approach may even protect patients from harms due to ‘blind spots’ in subspecialty- or discipline-silos. How many times have you heard of a patient who had been prescribed drugs that are known to interact negatively with one another because they have been prescribed those drugs by two different doctors from two different disciplines?

Should we change the way we use those terms?

So, what my doctor was referring to in the clinic last week is actually an interdisciplinary approach as opposed to a multidisciplinary approach. That much is clear now. But I totally understand how the terms can get easily mixed up. Doctors (including myself) are more familiar with the term multidisciplinary approach compared to the interdisciplinary approach. So, if the multidisciplinary approach is just the usual patient care given to almost all patients, then should we just stop using the term in the everyday patient encounter and use the term interdisciplinary approach when the context is right? I suppose we could be more accurate than we currently are. But, I doubt that using the right term would change the way things are done in healthcare settings and affect patient outcomes greatly, as long as the level of patient care is provided accordingly – multidisciplinary or interdisciplinary.


Resources

  1. An interdisciplinary approach to caring by health.vic
  2. Jessup RL 2007, ‘Interdisciplinary versus multidisciplinary care teams: do we understand the difference?’Australian Health Review, 31(3):330-331.
  3. Epstein NE. Multidisciplinary in-hospital teams improve patient outcomes: A reviewSurg Neurol Int. 2014;5(Suppl 7):S295–S303. Published 2014 Aug 28. doi:10.4103/2152-7806.139612

Image by ErikaWittlieb from Pixabay

 

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