Dr. George is a first-year resident, Family Medicine, Duke University Health System, Durham, North Carolina. Dr. Frush is professor of pediatrics, Duke University School of Medicine, clinical professor, Duke School of Nursing, and chief patient safety officer, Duke University Health System, Durham, North Carolina. Dr. Michener is professor and chair, Department of Community and Family Medicine, Duke University School of Medicine, and clinical professor, Duke School of Nursing, Durham, North Carolina.
Acad Med. 2013 Nov;88(11):1603-5. doi: 10.1097/ACM.0b013e3182a7f785.
Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.
医疗协调失败反映了沟通以及医生在共同团队领导方面更大的系统缺陷。传统的医疗保健和医学教育既不关注，也不激发对跨阶段和跨地点的护理协调挑战的应对。作者认为，对护理连续性中存在的差距缺乏关注，导致医生试图充当将医疗保健系统凝聚在一起的胶合剂。此外，医学生和住院医师几乎没有机会对护理流程提供反馈，也很少得到评估和提出可能改进措施所需的培训和支持。作者认为，这种缺乏机会导致了医生的愤世嫉俗、冷漠和倦怠。他们支持文化和医学教育的转变，以便学生和住院医师接受培训并受到激励，充当发起和加速积极变革的催化剂。要成为催化剂医生，学员需要与患者、员工和教师合作的工具；实施变革的培训；以及将这项工作视为医生角色固有部分的认知。作者建议医学院将跨专业培训视为医学教育的必要组成部分，并鼓励未来的医生在“纯粹临床”领域之外发展。他们得出的结论是，医生催化剂和团队合作对于改善医疗协调、减少冷漠和倦怠以及支持最佳患者结果都是必不可少的。
