Working in teams

wardround cover

Good, reliable communication between members is vital if a team is to function effectively. Dr Natalie Hayes, MDU medico-legal adviser, explains the essentials for working in a multidisciplinary team.

You are the F2 on call overnight for the general medical wards and you are asked to review a patient in the middle of the night. You have never seen the patient before, the nurses on the ward cannot find the patient's notes, and the FY doctor on call during the day shift did not hand over the patient to you. The nurses tell you that the patient takes a lot of medications and these all need prescribing; there is no letter from the GP and the patient has no known family. The nursing staff are about to do their drug round and you are being bleeped to see another patient on another ward. It is your first shift in the hospital. What do you do?

Later the same evening, nurses on a different ward ask you to see a patient who has become unwell. Again, the patient is unknown to you. The FY doctor on call during the day did not hand this case over to you either and you cannot read the entry in the notes made by the registrar who saw the patient last. The nurses think that the patient might need some repeat investigations but aren't sure which ones. What do you do?

These sound like nightmare scenarios for a first shift in a new hospital, but they are all too common examples of the problems we can face when we don't work as a team. If you are new to the team, department or hospital, there can be a bewildering number of new faces and names to learn, local policies to become familiar with, not to mention a new specialty to grasp. Finding out who your colleagues are, who does what, and who to go to for help when things go wrong is an essential first step.

Good record keeping

Entries in patient records must be accurate, clear and legible. This is a professional requirement, not just something that those following you on duty will be grateful for. And when you hand over task lists and patient information to colleagues at the end of your shift, you should make sure that this information is as detailed as possible. Include any tasks that you need to delegate because you were unable to complete them yourself. It is important to be clear when your responsibility for your patients' care has ended, but you must also be sure who this responsibility has passed to and that they are aware of this.

In the first scenario, the patient's medications should ideally have been prescribed by the admitting doctor. If this wasn't possible, the task should have been handed over to you directly, and the GP should have been contacted for a list of what the patient is taking. In the second scenario, the patient should have been mentioned to you specifically given that they are clearly unwell. The registrar's entry in the notes should be legible, and the nursing records should contain essential information about the patient's status earlier in the day and the medical team's plan. If this was all as it should have been, your job in reviewing the patient would have been made much easier. More importantly, it is likely that the patient could have been assessed more accurately and treated quicker. Now that the majority of junior doctors (and some senior ones too) work shifts, detailed and thorough handovers between doctors coming on and going off duty is more important than ever for good patient care. You must not rely on colleagues such as the nursing team to hand over information for you, but if you have information that may assist other multidisciplinary team members looking after the patient, then you should of course pass it on.

Entries in patient records must be accurate, clear and legible.

The term multidisciplinary team usually refers to all healthcare professionals involved in the care of the patient. For you to play your part in the team, it is essential that you know who everyone is, their roles and how to contact them.

Each team member has specific expertise and experience which is likely to be different from yours. The team structure works best when all members seek advice from each other appropriately and promptly, making sure that referral documentation is clear and correctly filed in the patient's notes. You may have gained experience from previous jobs – wound dressing or helping a patient mobilise, say – but it is essential that patient care is co-ordinated and documented carefully by the person with responsibility for each task.

Failure to show respect can cause just as many problems as poor communication.

A common source of difficulty within teams is when medical or nursing staff fail to involve members of the wider patient care team such as physiotherapists, speech and language therapists and dieticians, early enough in the patient's admission. This can lead to delay in the patient receiving essential aspects of care, poorer progress and even delayed discharge.

Respecting others

Situations like the two examples outlined earlier can test the patience of even the most saintly amongst us and when things go wrong, it can be tempting to vent our frustrations on those around at the time. This will almost certainly make a tricky situation worse. Next to communication, respect for colleagues is a fundamental aspect of working in a team. Failure to show respect can cause just as many problems as poor communication. While it may be true that a team member may have forgotten to do something or overlooked a task, such as prescribing the medication or handing it over, how you deal with such a situation will have a direct effect on your relationship with that individual, and on the effectiveness of the team as a whole.

Clearly, if a member of the team repeatedly fails to fulfil their roles and responsibilities, and this compromises patient safety, you have a professional obligation to act on your concerns. However, you must balance this against your duty to treat all colleagues fairly and with respect. While you may be justified in pointing out the difficulties the absence of a proper hand over and the patient's notes have created, you must do so in a manner that is respectful and polite.

Finally, be extremely careful when in earshot of your patients. As one of their doctors, they will naturally be very interested in all you have to say.

If this is a rather negative comment on your colleagues' actions or competence for example, you may unwittingly have damaged the confidence the patient has in your colleague, the team, or even the hospital as a whole.

Working in a team can offer some of the most challenging but also the most rewarding of experiences life as a junior doctor can offer. Above all, being an effective team member and helping to ensure the team works well is vital for good patient care.

Guidance for effective teamwork

  • Communicate– the value of good communication, written or verbal, simply can't be overstated. Say it, write it down, tell someone you've written it down...you get the picture.
  • Mind your manners – treat all your colleagues fairly and with respect, and remember that you are entitled to the same in return.
  • Know your place – be clear on what your role is, what you are responsible for, and how your colleagues can help you. Know how you can help them too.
  • Ask for help - value the expertise of your team members and use it; don't be afraid to seek advice, or to offer it too.
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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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