I have read truths, half truths and misinformation about the multidisciplinary team approach to medical care and decided to take out time and seek the veracity of the matter. Many health workers and the public misunderstand issues when they say "healthcare is multidisciplinary" instead of "medical/hospital care being multidisciplinary", they're oblivious of the actual meaning of a section being multidisciplinary. It is wrong to say that the health sector is multidisciplinary because its not made up of disciplines but of sections/fields that are then made up of disciplines eg the field of pharmacy has 3 general disciplines, pharmaceutics, medical chemistry/pharmacognosy and pharmacy practice. Multidisciplinary is not multi professional.

 

Before any reasonable discuss can be effected, some concepts need to be understood. They include, health care, medical care, hospital care, nursing care, the hospital, disciplines and medicine. I ask for your patience and understanding because the article is more of definition of basic terms used everyday but wrongly.

 

Health care is a broad term that means the entire process involved in the diagnosis, treatment and prevention of disease, illness, injury and other physical and mental impairments in human beings. Healthcare is granted in different settings-nursing homes, clinics, maternity homes, dispensary/pharmacy/drug stores, medical laboratories and research/biomedical research facilities. Health care in Nigeria involves but not exclusively, hospital care, medical care, nursing care, drugs and pharmaceuticals etc. (I will limit my discussion to these).

 

Medical care is the provision by a physician of services related to maintenance of health, prevention of health, prevention of illness and treatment of illness or injury(Mosby's Medical Dictionary 8th Edition, 2009). Recent developments accords certain highly trained nurses like Nurse Practitioners and some others like Physician Assistant some form of medical care but under the supervision of a physician, in places like US, UK.(not yet in Nigeria for obvious reasons of lack of regulation and potential for abuse).

 

Nursing care is care provided by a skilled nurse while Hospital care involves both medical and or nursing care given in the hospital.

 

Pharmaceuticals/drugs is the purview of the pharmacist, from need for a drug, to its production and monitoring of adverse effects(but not prescription except in certain circumstances and not of all drugs). It is dormained in pharmaceutical companies, dispensaries, pharmacies and drug stores, also with regulating bodies like our own NAFDAC.

 

A Hospital is one of health care institutions (this suggests health care has other institutions) providing patient treatment with specialized staff and equipment. It's distinguished from other medical facilities(nursing homes, clinics, hospice)by their ability to admit and care for inpatients. They're largely staffed by medical practitioners (physicians, surgeons and nurses) and support units including dispensary or pharmacy, medical lab sciences, and the nonmedical units like medical records, information management, clinical engineering/biomed, security etc

 

Medicine(Conventional/Scientific/Mainstream Medicine) according to the Oxford English Dictionary, is the field that mixes applied science with art in the diagnosis, treatment and prevention of diseases in human beings. It is generally conducted within the health care systems as medical/hospital care.

 

A discipline is knowledge or concentration in one academic field of study or profession ie the branches of the academic field of medicine are commonly referred to as the medical disciplines which corresponds to the systems of an individual and disorders that can affect him. They're related as such that they revolve around the sick person getting well and remaining well.

 

People with a disciplinary knowledge associated with that discipline and profession are referred to as experts and specialists after satisfying an examining body. In medicine, they take charge of the tertiary care medical services as consultants in charge of patient care and training of medical students and doctors.

 

Medical care specialists(doctors)/disciplines are actually a heterogeneous group of professionals who came together over time, due to a convergence of interest, to forge a common pathway culminating in MBBS, after which(internship and youth service), everyone follows his discipline. They include Allergy and Immunology, Anaesthesiology, .....Radiology, Surgery and Urology and are domiciled in the hospital. Suffice it to say that there are other disciplines with borrowed services in the hospital for ease of access to the patient, like some pharmaceutical services(disciplines), dieticians, social services etc

 

A multidisciplinary approach according to a research done by the European Network of Universities, involves drawing appropriately from multiple disciplines to redefine problems outside of normal boundaries and reach solutions based on a new understanding of complex situations. Hospital/Medical care is multidisciplinary because knowledge is drawn appropriately from the multiple disciplines of medicine to redefine the problem of the sick person. For instance, a middle aged man comes to hospital because of poor sleep and headache. The specialist physician sees first and realises during history and examination that there was period of leg swelling and raised blood pressure respectively, on further enquiry he leant patient lost his life savings two months earlier to fraudsters and has been having low mood and contemplating suicide. The physician may have to do some investigations, he refers the patient to the pathologist(a discipline specialized in making diagnosis with human samples) but sometimes, the patient maybe too sick to go to the pathologists office(the laboratory) in which case a phlebotomist or lab scientist or nurse or any doctor gets the sample to the pathologist. The pathologist activates the lab scientist and other lab workers, after which he analyses the findings to report back to the physician. The physician also invites the cardiologist (a specialist who deals with conditions of the heart and blood vessels), who may want to find out more about the heart of this patient. He may involve the radiologist (a discipline specialised in making diagnosis with images), who will involve the radiographer in the technical aspect. The physician will definitely involve the psychiatrist (another medical discipline specialized in behaviour,the mind and its diseases). This is a picture of multidisciplinary approach to the medical management of a patient. We should bear in mind that for all the specialists/disciplines, there are also nurses who according to their job description and oath, aid the doctor in his work.

 

In summary, health care has subsections which individually have their disciplines. Medicine(a subsection of health), which is principal in hospital/medical care employs multidisciplinary approach in the diagnosis, treatment of diseases and maintenance of health, through its mainstream disciplines and auxiliary disciplines co-opted from other subsections of the health sector. Before I sign out, I just remembered how a friend argued that he has never seen a person that is all flesh or all bones, that the health care system needs all the sectors to function properly. His assertion was true but wrongly applied. Yes, wrong because the section of health care ie "hospital and medical care" does not necessarily need other health sectors to function (Although for best outcome, a part of their services may be needed), What it needs is all the disciplines in the medical sector to work efficiently. Without the dispensary, the hospital can function. Patients can get drugs outside, provided the regulatory bodies are functional. For the records department, we all have our libraries at home, do we need a records staff to file or retrieve our books and documents for us? Especially now information is computerised making patient information a click away. For the laboratory work, every pathologist is trained to do everything the lab scientist does and every doctor can nurse his patient back to health. The saying that doctors care, but God heals sums it up better. It is not a matter of jack of all trade, but like a said earlier, medicine/doctors are a group of heterogenous professionals who came together over time(just like the big bang theory),due to convergence of interest to forge a common pathway culminating in MBBS. After which specialisation occurs. Its a complete order that will not admit any other poser by hook or crook, its borders has been marked and if any one so wishes to be like them, the pathway is open. The government in its wisdom brought a part of other health sectors into the hospital for the patients sake and not for them to usurp the system and direct how the hospital works.

 

I will be throwing more light on other contentious areas as regards the problems in our medical/health sector, for now however, criticisms are welcome.

 

By Eleazu, Franklin Ifeanyi