The Team Approach

Chapter 27
The Team Approach


Louise Warburton1 and Sarah Ryan2


1 Shropshire Community NHS Trust; Keele University, Keele, UK


2 Haywood Hospital, Stoke on Trent, UK


Many rheumatological conditions, including rheumatoid arthritis (RA), are not curable and the patient faces the challenge of learning to live with their symptoms on a daily basis. Input from a variety of team members can be required to help the patient maximize their physical, psychological and social function. Modern treatments such as combination disease‐modifying antirheumatic drugs and anti‐TNF drugs have improved the outlook for the patient with RA, and the patient lives with the disease, rather than the disease controlling the patient’s life. Rheumatoid arthritis will be used as a model to illustrate how a team approach may work in practice.


The patient as a member of the multidisciplinary team


The multidisciplinary team is made up of many people (Box 27.1). Sometimes, the patient will require input from all the members of the team and sometimes very few. The approach needs to be flexible. Each member of the team will deal with a different part of the disease and have different skills and approaches to care. No single member of the team can function in isolation and a good team will allow the patient access to them whenever required.


In the United Kingdom, the National Institute for Health and Care Excellence (NICE) emphasizes that the patient is a pivotal member of the team and that all treatment should be based on a discussion of the patient’s needs and preferences, with patients having ongoing access to a multidisciplinary team to assess the effect of the condition on their day‐to‐day activities as well as their mood, social, work and leisure activities (Box 27.2).


A single member of the team, the ‘named team member’, should have overall responsibility for that patient’s care, and be responsible for co‐ordinating their care. This person should be accessible quickly by the patient in case of flare management and other problems which require prompt attention.


It is important to involve patients in decisions about their care. There are now many resources available for clinicians and patients to use, to aid in making difficult decisions such as whether or not to start disease‐modifying treatments in RA. The MDT should be aware of these clinical decision aids and incorporate them into their everyday care (Box 27.3).

Nov 5, 2018 | Posted by in RHEUMATOLOGY | Comments Off on The Team Approach
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