It Takes a Village

I look around the room of people gathered for our liver transplant meeting, Monday at 12pm sharp. It’s in a crowded conference room with a screen projecting information relevant to all the patients we need to discuss.

I gaze over to identify everyone here, each with a million other things on their to-do list, but showing up because they all have a role in the care of our patients.

There are doctors- transplant surgeons, hepatologists, & anesthesiologists.

social workers.

nurse practitioners.

physician assistants.

pharmacists.

nurses.

dietitians.

care managers.

physical therapists.

occupational therapists.

psychologists.

addiction specialists.

transplant coordinators.

..and the countless number of other wonderful humans up on the floors making a difference- office managers, MAs, floor clerks, interpreters, etc. I can’t even begin to list all the job roles that touch the lives of someone moving along the road to and from a transplant.

We all participate in the discussion of patients currently being worked up for potential liver transplant, those on the transplant list anxiously waiting, and those patients who’ve received a transplant who are in need of management regarding post-operative care. Every single person in that room plays a vital role in the care of these individuals, and we forget to take a step back and really honor this fluid teamwork.

I’m taken aback every time the social worker or psychologist speaks about the potential barriers or home life situation of a patient being considered for transplant. Did I not get a social history earlier today? How did they basically dive directly into this patient’s soul and extract so much information? How did they get that person to let their guard down? I can’t do their job.

We discuss another patient who’s already undergone surgery, concerned about a potential interaction with a new medication affecting their immunosuppression doses. Without a hitch, the transplant pharmacist calmly recommends dosing and when to next check their blood levels of this certain drug. Pharmacists save lives every day by ensuring that those of us putting in orders aren’t doing anything outrageously stupid. I can’t do their job.

 I love this image from the transplant team at  UPMC . A wonderful representation of patient centered care through the work of many

I love this image from the transplant team at UPMC. A wonderful representation of patient centered care through the work of many

The PAs/NPs in our outpatient setting hold down the week to week follow up and management of this range of patients. They are focused, dedicated to really knowing the ins and outs of their care, submitting prior authorizations for medications, following up endless amounts of blood work, calling patients with follow up management, and are able to recall the tiniest details of their lives years later when it comes up.

And then there’s the people on our team with a mythical job that I could not even begin to comprehend. The amount of work that is required of a transplant coordinator is incomprehensible. I have no idea what must happen behind the scenes, but I assure you it is a foreign language that would leave me huddled in a corner confused and overwhelmed. I most certainly, can not do their job.

I’m not a dietitian either, or an occupational or physical therapist. So you can imagine why, despite dabbling in learning about all of these fields, I take their recommendations verbatim to apply to any patient. It’s what they do, and it should all be valued.

Gone are the days (thank goodness!) where doctors were at the top of some self-proclaimed hierarchy in determining what was best for a patient. The paternalism of physicians trickled throughout so that despite a nurse having years more experience, there was hesitancy to speak up. The concept of “ancillary staff” makes me cringe a little. There is nothing ancillary about anyone in this room, so can we stop calling it that?

On rare occasions I see it creep up in an overzealous intern, thinking he/she is suddenly an expert with a newly minted medical degree and thus able to dismiss a nurse or pharmacist’s recommendations. This is not an “us vs. them” scenario despite every medical TV show trying to glorify it as such. We are a team that is only as strong as the person least willing to speak up in their area of expertise.

So this is just a little narrative to say THANK YOU for everyone who takes part in caring for who’s really at the center- you know, the patient. This is a circle (not a ladder), so say hi to your healthcare neighbor and smile. You need them.

Love,

Shanny DO

*(For more information on the wonderful team and transplant program at my hospital, check out the website here! <3 )