Persaud-Sharma Dharam, Govea Marien, Hernandez Robert
Internal Medicine, Kendall Regional Medical Center, Herbert Wertheim College of Medicine Florida International University, Miami, USA.
Internal Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2020 Jun 9;12(6):e8535. doi: 10.7759/cureus.8535.
The practice of interdisciplinary medicine is one of the most effective and cooperative forms of medical management, which optimizes clinical care and outcomes for a patient. This model of care affords the patient the benefit of receiving the best available therapeutic options from specialists who are experts in their respective disciplines, which would otherwise be limited when compared with the clinical expertise from a single provider managing multiple co-morbidities. However, poor communication between each specialized team managing a patient's care can result in redundancies and superfluous treatment that can have deleterious clinical outcomes that impede the physician-patient relationship and question the bioethical principles of clinical practice. Having a medical provider like an internist who is the primary medical provider for a patient anchors reinforces the physician-patient relationship through familiarity and continuous involvement in the gross clinical course of a patient. Specialty care provides a very focused and limiting scope of practice. However, whether practicing specialty care or being a generalist, utilizing clinical tools, such as the biopsychosocial model and routinely using bioethical principles during clinical encounters, not only help extract pertinent information from the patient's medical history but also furthers the continuity of clinical care by understanding the global context of the patient's medical history. This is a case analysis that exemplifies sub-optimal outcomes in patient care due to undermining the critical role of an internist in patient care and clinical management in addition to challenging several bioethical principles of clinical care. It also highlights the importance of how using the biopsychosocial model of care can avoid clinical errors, improve interdisciplinary and patient communication, and, ultimately, optimize the patient-physician relationship and clinical care.
跨学科医学实践是医疗管理中最有效且协作性最强的形式之一,它能优化患者的临床护理及治疗结果。这种护理模式使患者受益于从各学科专家处获得的最佳治疗选择,而若由单一医疗服务提供者处理多种合并症,相比之下临床专业知识会受限。然而,负责患者护理的各专业团队之间沟通不畅可能导致重复和不必要的治疗,从而产生有害的临床后果,这会妨碍医患关系,并引发对临床实践生物伦理原则的质疑。有像内科医生这样作为患者主要医疗服务提供者的角色,通过熟悉并持续参与患者的总体临床病程,能强化医患关系。专科护理提供的是非常有针对性且范围有限的医疗服务。然而,无论是从事专科护理还是作为通科医生,运用临床工具,如生物心理社会模型,并在临床诊疗过程中常规应用生物伦理原则,不仅有助于从患者病史中提取相关信息,还能通过了解患者病史的整体背景促进临床护理的连续性。这是一个病例分析,它例证了由于忽视内科医生在患者护理和临床管理中的关键作用以及挑战临床护理的若干生物伦理原则而导致患者护理效果欠佳的情况。它还强调了运用生物心理社会护理模式如何能够避免临床错误、改善跨学科及医患沟通,并最终优化医患关系和临床护理的重要性。