By Chelsea Conaboy, Globe Staff
The patient in intensive care had kidney, liver, and lung failure, plus a rash. Nine specialty groups were called in to consult. During 11 days on the unit, at least 40 doctors were part of the mans care. But none pinned down a diagnosis.
In a perspective piece in the New England Journal of Medicine this week, two Yale doctors involved in the mans care cited the case as an example of the bystander effect in medicine. Just as strangers who witness a crime may do nothing, willing to dismiss the incident as someone elses problem, doctors without ownership in a patients care may not act, write Drs. Robert Stavert and Jason Lott, residents in dermatology at Yale School of Medicine. They write:
The case wasnt unique, they said in an interview. They had seen such an effect before, they said, and friends and colleagues they spoke with said they had experienced similar things at other institutions. Increased specialization among doctors plus new rules limiting how many hours residents can work have led to a greater number of doctors being involved in a single patients care, they said, but there has not been of a response to ensure that doctors know each other and have the skills to work as a team.
Getting everyone together can be challenging if theres not systems in place that can make that happen, Stavert said.
Some medical schools have begun investing time in team-building and communications. Brown Universitys Alpert Medical School last year introduced a transitional program for students between their second and third years, before they begin working on hospital wards.
The students spend time getting to know the culture of certain specialties, including surgery and pediatrics, and go through training on how to communicate with specialists about patient needs and to ensure proper follow-up.
Dr. Paul George, a family physician and a course leader for the clerkship, said its a start, but more such training is needed. He echoed a theme the Yale physicians wrote about: The growth of accountable care organizations, in which doctors are rewarded for collaborating with each other to keep their patients healthy, could help.
Im now getting more notes from specialists than ever before, George said.
Hospital programs aimed at helping doctors get to know one another, such as interdisciplinary grand rounds, also could improve communication, the authors said.
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Yale doctors: ‘Bystander effect’ in medicine hinders patient care