Team Work
With the changing season the Canadian geese and mallards who live around us on the Northeast corner of Narragansett Bay are gathering into larger and larger groups as they prepare for migration to their winter feeding grounds. This summer we counted only two dozen Canadian geese and six mallard ducks. Yesterday morning as the sky turned melon before the debut of the rising sun a curtain of geese honked past in v-formation, over a hundred in the group.
For those who don’t know Rhode Island the bay is an arm of the Atlantic Ocean punched into the east side of the state creating 400 miles of coast line. We look out at a lighthouse built in 1868 to guide navigators up the river toward Providence. As the birds congregate to support each other in this seasonal migration, a journey done for thousands of years, I pause to reflect on teams and team work. Geese mate for life and cooperate in flight. The V-formation conserves energy and keeps other geese in view. Much like bike racers, each goose flies slightly above or ahead of the bird in front, reducing the resistance of the wind, lessening the energy expenditure. The goose in the lead works the hardest, when weary s/he falls back and another takes the lead. The honking is communication.
I’ve worked in medicine long enough to experience effective and ineffective teams. Of late, dozens of articles have been written about teamwork in primary care, especially since we have focused on the patient centered medical home and the advanced patient centered medical home. The medical home concept was hatched in the 1960s by pediatricians to care for children with special needs. The doctor-patient relationship may be central to good care, but it takes a team to provide care for patients with needs beyond prescribing medications, removing lumps and bumps, and giving immunizations. And as we focus on the social determinants of health that define a patient’s life we need a village. I am using terms that may not be familiar if you don’t live and breathe health care every day. The doctor-patient relationship is pretty straight forward. The medical home is the group of professionals who work together to deliver whole person care. Social determinants of health are the environment we are born into, live, learn, work, play and worship in, as well as our age which affect a wide range of health, functioning, quality of life outcomes and risks. My life as a physician is easier and the medical home functions better if there is a pharmacist who can help sort through the complexity of multiple medications and a psychologist or social worker who can help address the interplay between the mind and body or locate resources to help a patient identify transportation or food pantries. A case manager or community health worker who visits patients or does phone follow up with challenging patients is a great help as well. Some clinics offer this, many do not.
As migrating geese and other birds teach us, teamwork isn’t’ rocket science. It is a journey that has been done for millennia. It takes communication, commitment to working in partnership, asking for help, and defining roles. In medical home lingo, that is huddles, working at the top of your license, and care management. Unfortunately, the bean counters who run health these days often pay lip service to providing patient-centered care without investing in or allowing team members the flexibility or leadership to work together. Recently I did battle so my medical assistant could clock in fifteen minutes early, at 7:45, so we could huddle and be ready to see patients at 8 a.m. I have been pushing for monthly physician meetings so we can do shared problem solving and planning.A colleague complained last week—health care has lost its soul. That loss of soul results in burnout. Burnt out physicians, nurses and front desk staff are not healers. So where do we start?
We can take a lesson from the geese. It may take a revolution to fix our broken health care system, but we can examine the team we have and figure out how to communicate, and how to talk about the work that needs to be done for the day. We can ask for help when we need it and respond when our compatriots are getting weary. We can push the bean counters to support us in our efforts to deliver good patient care.Even in current times, I still believe that each of has a kernel of goodness. In that vein I will end with one of my favorite poets, Mary Oliver and her poem Wild Geese.
…Meanwhile the wild geese, high in the clean blue air,are heading home again.Whoever you are, no matter how lonely, the world offers itself to your imagination,calls to you like the wild geese, harsh and exciting --over and over announcing your place in the family of things.
I can hear them clacking overhead now.