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Working as part of the MDT

For those of you who don’t have much clinical experience, you may not quite understand what is meant by the ‘multidisciplinary team’ or MDT. Well you’re in luck because I’m going to spell it out to you and give you my experience as a PA within the MDT.

In healthcare, the MDT is a group of professionals from different disciplines that provide their expertise and services to aid in the care and safe discharge of a patient. So, for a relatively healthy, young person who has had a short hospital stay, this could include a doctor, a nurse and a pharmacist. For an older patient who has more complex health and social care needs, this could include the same as before, as well as physiotherapists, mental health officers, occupational therapists, social workers and more. Each patient will have a unique situation and therefore the team that cares for them will need to meet those individual needs. It’s about providing a holistic approach to patient care, not just treating a disease.

As a Physician Associate, your role within the MDT will differ depending on whether you work in primary care, secondary care and even the speciality you work in. In my experience working in Cardiology, I work closely alongside the doctors taking part in consultant-led ward rounds, completing jobs generated from the ward round and seeing patients during the day if they’re unwell. An important aspect of this is also communicating this information with the nursing staff who are looking after the patient. As a PA, you get to know your nursing team quite well so you’re more aware of the things that need to be handed over to things get done efficiently.

An example might be you’re on the ward round and the Consultant asks for a patient to have a urine dip. If the nurse is not able to be on the ward round with you (they’re busy people it’s not always possible!) they rely on you to let them know once the ward round is over. Failing that, the nurses will read through the notes when they get a moment, which could be at the end of the day, and realise they missed a job. By this point we’ve wasted a whole day where a patient may have needed antibiotics for a UTI. This is just an example and that’s not to say a member of the medical team couldn’t have just done the urine dip themselves but these things do happen. Communication with your team is key. I work across 3 different ward areas and know most of the nurses quite well so the communication comes quite naturally. It can be tougher for trainees who don’t know the department that well because of their on-call commitments and rotations. This is where PAs can really help with continuity of care and knowledge of their department. It can also mean that the nurses mainly come to you with issues because they know you better!

Many patients will have issues that fall outside of your speciality so working within an MDT can also mean discussions with other departments and specialists. This could be a consultant, registrar, specialist nurse or someone that’s more of an expert on that subject than you. It can be daunting but if you know your patient, then you’re the right person for the job. I used to dread these jobs because I never seemed to know the answers to their questions, but this all comes with practise and learning to anticipate the information they want to know. If you don’t know the patient well, the trick here is to either get a handover from someone who does, or go old school and just read through the notes! And don’t forget to be documenting all your conversations so someone doesn’t go and repeat the job the next day. Nothing better than calling a consultant and have them say ‘oh I spoke to someone about this yesterday, haven’t you seen the notes?’. Document everything.

Discharging patients can involve several members of the MDT. Physiotherapists will assess whether patients are at their mobility baseline and if they need any equipment such as zimmer frames or walking sticks. Occupational therapists will look at whether patients can independently look after themselves and advise on the need for a package of care or downstairs living. These professionals often work closely together to ensure patients are safe to leave hospital and go home. They also work closely with the medical team including PAs to find out if a patient is medically fit for discharge or information about prognosis. Working together means the patient will have the best chance of coping safely at home and hopefully avoid coming back to hospital.

There are so many healthcare professionals you will work alongside in the NHS. The ones I’ve mentioned are just a small snapshot of reality. You will work with pharmacists, podiatrists, specialist nurses, mental health workers, physiologists, the list goes on and on. A lot of the time, as long as the task doesn’t involve prescribing or requesting imaging with ionising radiation, you’ll find that you can help. Explaining your role as a PA and how you relate to the patient’s care is important for the other members of the MDT. That way they’ll know when they need your help and use you to your full potential.

Hopefully you’ve got more of an understanding on what the MDT is and how PAs can fit into this.

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