Dr Burnt-out writes to Pulse about the rise of shared decision-making in primary care following the Fuller stocktake report
Dear Pulse,
It has come to my attention that many recent articles and opinion pieces in the GP press have reported that GPs should now work as part of multidisciplinary teams (MDTs) and neighbourhood teams following the publication of the Fuller stocktake report, which outlined the future direction of general practice.
The opinion seems to have taken hold in primary care that decision-making within an MDT and neighbourhood team is inherently somehow much better and more appropriate than individual and ‘not-shared’ decision-making in terms of patient management and clinical decisions.
So, are decisions made by teams and multidisciplinary groups always better and more superior than those made by GPs and other clinicians working alone? Is working together in large teams the most valid, efficient and effective way of making these decisions? Are the decisions that are made proven to be superior? Is there not huge scope for inefficiency, poor time-management, duplication and confusion when multiple parties are involved in decision-making? And what types of decisions are being made?
A lot of decisions we make as GPs are binary; ‘either/or’ decisions. For example, after you see a patient:
- Either you prescribe medication, such as antibiotics, or you don’t
- Either you make a specialist referral, or you don’t
- Either you refer someone into hospital, or you don’t
- Either you agree to do what the patient wants you to do, or you don’t
- Either you do something, or you do nothing
- Either you request investigations, or you don’t
Many decisions we make as GPs are of this nature. Can someone please tell me how decision-making as part of a large MDT or neighbourhood team can help with these decisions, rather than an individual experienced clinician using all their experience and clinical acumen?
Surely, an experienced GP making these decisions is likely to be more time-efficient, accurate and appropriate than any decision made by a group or committee of various people.
The way the PCN myth has developed has included the notion that working in an MDT is somehow better, more inclusive, more accurate, more moral and more efficient than decisions, diagnoses and management plans made by an experienced individual GP.
It isn’t.
Yours faithfully,
Dr Burnt-out
Dr Burnt-out is a GP in London
what is the sell by date on the DES?
MDT = Compulsive Wafflers Squabbling for Eternity – Oops that’s CWSE – someone has an incorrect lettered abbreviation?
Case conferences, MDTs in University Hospital Trusts are a good learning and ideas experience for hospital doctors, where patients are based in hospital beds (if there are any beds in hospitals any more) for common, serious or unusual cases where a presentation of the patient case, reviews of similar by doctors and their colleagues and various ideas for management of the case in an informal conference hall, quite possibly as a weekly lunchtime event by different doctors, as a regular event, and easily accessed within that setting. In primary care, do experienced individual GPs need their time available to patients more constrained by inefficient MDT, neighbourhood committees who have never even seen your patient and be useless? More likely, regular cases presented weekly within a particular practice would be more helpful and more efficient, if GPs were allowed sufficient time as always. Good item by Dr Burnt-out, London 2023; different (yet somehow sadly similar) to ‘Great Fire of London’, 1666.
I hope things improve greatly.
MDT are of use in specific areas of health care e.g. end of life care in a patient with multiple complex medical problems.
But yes, as stated in this article, we as GPs, make much better decisions when the choice is binary.
The increasing push toward ‘team working’ is not about better decisions it is about further eroding the status/authority of the GP
Never forget the government hate us. They are deeply jealous of our enduring popularity with the public compared to their own reputation as self-serving despots.
The government particularly despise our self-employed status and would love nothing more than to turn us into a salaried service they could control like puppets on a string.