The Benefits of Multidisciplinary Working
Why do I like Wednesdays?
I work in an NHS setting in St Mary’s hospital, Paddington, London once a week. I work in two clinics.
In the morning, I work in the Orthopaedic Foot & Ankle clinic and in the afternoon, I work in the Falls clinic under the care of the Elderly team.
I love Wednesdays. It is the favourite day of the week for me. I tend to jump out of bed and have a spring in my step as I quite never know what will happen. No two Wednesdays are ever the same. All I know, is that I will have that a little more knowledge at the end of the day then I went in and of what I already know, it will be further reinforced.
I work with a variety of different specialists in a hospital outpatients’ setting from varying from various consultants to health care professionals. There is an amazing energy in both clinics because we are all of similar mind sets – open mindedness, together with a need to want to further improve our own skill sets and to provide the best treatment possible for our patients.
How does the Foot & Ankle clinic work?
The morning clinic starts off with an MDT (Multi-disciplinary team) meeting. It roughly begins around 8.40am.
Usually on a Tuesday afternoon, we get the list of patients who are going to be discussed. This is a tremendous help to me so that I can prepare and be ready to present (remember speaking in Public – gives me stage fright). The MDT co-ordinator also knows I prefer to go last rather than earlier so that I have calmed my nerves down.
In the meeting, we have the following medical disciplines and the MDT co-ordinator who is in charge of co-ordinating the patients’ list and ensuring all their scans are up to date and they have sent in their pain dairy in.
Diagram: Who is involved at the MDT meeting?
What is the purpose of the MDT Meeting?
The advantage of this MDT meeting is being able to discuss a patient with all these specialists in one room. It is a great way to review a patient’s case
For example, a patient may present with ankle pain to the Foot & Ankle team. The patient has a known history of Osteoarthritis and has had a previous fusion at the ankle joint. When examining, it may transpire that the ankle pain is focussed mainly on the lateral aspect of the ankle but the weight bearing x-rays do not indicate any sign of arthritis and the fusion has healed.
It may cross the clinician’s mind that it maybe the subtalar joint causing the pain – maybe there is lateral subtalar joint impingement but you are not sure. You need a diagnostic injection which could be offered in clinic but it maybe better to refer them to Radiology who can carry out an Ultrasound scan (plus/minus the injection)and the patient will be provided with a pain diary.
Filling in the pain diary by the patient is the key to planning the next stage of treatment and the importance of this is stressed to the patient and also advised to return it back to the MDT Co-ordinator so that the case can be then, reviewed in the MDT meeting.
The Radiologist who carried out the injection will write a detailed report of his/her assessment and treatment plan.
The case will be discussed in the MDT meeting to plan the next stage. If the injection worked, then they will suitable for further surgery with a desired effect of pain relief (this option has been discussed with the patient prior to the injection, at the foot clinic appointment and they know that if it has worked, they will be added for surgery) but if there was no pain relief, then it may be worth reviewing the patient in clinic. A report outlining the findings is sent to the patient
What do I get out of the clinic?
I come in the clinic as an empty sponge and I come out saturated with so much useful information. Plus, you have this added bonus to being able to bounce ideas of each other. For example it could be the foot and ankle consultants deciding on the best approach for a particular type of surgery or where to make the best incision and what their past experience has been. Or whether it would be better to view the Peroneal tendons with Ultrasound scan or would the Radiologist consider MRI with contrast before considering surgery
We have the highest respect for each other and there is network and comradery of medical professionals discussing feet. What is not to LOVE – one has to be foot nerdy?
It is like a mine field of educational facts with best minds all in one room together like BOOM!!! (like an explosion of knowledge). And this is before the actual clinic has started.
The clinic itself begins after this meeting. We normally see 25-30 patients in a session between three or four clinicians. It can be very intense and at moments fairly stressful because your are always on the go but I would not change it for anything. I have been working here for the last 10 years.
What does this mean if you came to see me in my Private clinic?
If I suspect that your case needs further input, (prior to me prescribing suitable orthoses or individual exercise programme), maybe from a radiologist or the foot & ankle consultants’ or a lower limb specialist physiotherapy, I have excellent multi-disciplinary links to such a team and rest assured, we all work in a similar approach.