Seven surgeons offer advice on how to develop a successful multidisciplinary spine team.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
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Note: The following responses were lightly edited for style and clarity.
Question: What are your tips for building a strong multidisciplinary spine team?
Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): The future of medicine will be to build multidisciplinary teams that are focused on one specific disease. Spine care, with all the different providers (surgeon, pain management, chiropractic, physical therapy, occupational therapy) is perfectly suitable for this. In my practice, we have different providers under one roof. We are constantly communicating with each other, formally through case conferences and informally through curbside discussions about our patients. Our goal is to have complete integrated spine care where patients have access to the most appropriate provider based on their clinical needs.
Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): I think the most important feature of a successful multidisciplinary spine team is strong and open communication lines. The providers need to have easy access to one another to freely and efficiently exchange ideas, results and treatment plans. Patients will feel well taken care of if all their providers are communicating well and everyone is in the loop.
Rojeh Melikian, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Find like-minded people in different specialties (orthopedics, neurosurgery, pain management, etc.) who want to take the best care of patients. With everyone focused on that goal, everything else falls into place.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: I believe the best way to build a multidisciplinary team is to be a good listener. Listen to patient feedback when you refer them to a specialist, a physical therapy place or even a home care team. Refine your referrals and work with those that give your level of service to your satisfaction. Those that can play up, keep working with them, touch base with them, keep them in the loop during the cycle of patient care. Remember your referring physicians are also part of your team; send them notes from surgery, or interesting findings, in a secure way. Lastly, the patient also makes part of the care team. With patient buy-in, good outcomes will follow.
Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): A spinal surgeon needs to have effective associations with competent, well-known physicians and therapists who can provide support for optimizing preoperative condition and assessment, and postoperative recovery and rehabilitation. This includes physical therapy in the preop phase to strengthen and stabilize the spine; pain management in the preop and postop phases for injections and medication management; and a neurologist to perform necessary [electromyography] and nerve conduction studies to properly evaluate the patient for nerve entrapment syndromes, plexus syndromes and other neuropathies.
By assembling this multidisciplinary team, spine surgeons are able to effectively diagnose and construct a treatment protocol and surgical intervention, if necessary. Postoperatively, the same team is able to help rehabilitation of the patient. Fifty percent of a patient’s recovery will be in the surgery performed, and the other half will be their cooperation and ability to perform the necessary rehabilitation afterwards.This provides the best outcome with that type of multidisciplinary spine team.
Richard Chua, MD, Northwest NeuroSpecialists (Tucson, Ariz.): I think we have lost the art of directly speaking to each other, including members of our own multidisciplinary teams. With the advancement in digital communication, social media and the social distancing of the COVID-19 pandemic, we are communicating in a very different way. I still like to pick up the phone and call someone to discuss a patient.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Teamwork in the workplace has been demonstrated to increase efficiency, improve communication, expedite idea generation, distribute workload and establish a culture in which each employee feels a sense of belonging and empowerment. Teamwork is the identifying thread in attaining any common goal. A culture of objective-based commitment and strong leadership will bond those goals as priorities and solidify that team effort.
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