Team Care

The delivery of medical care is a team sport. Patients expect to see physicians, nurses, technicians, dietitians and aides working together in the hospital. Even the cleaning people have a valuable role in helping patients regain their health. Less familiar is the team approach in ambulatory medicine.

The care of diabetes has pioneered the use of teams. The diabetes nurse clinicians and educators are well trained in their fields and in most practice settings they have the flexibility to spend time with patients to individualize their care. A typical diabetes care team may consist of one physician, several nurse clinicians or physician assistants, a dietitian, several medical assistants and secretarial support caring for a defined group of patients. There are well-established goals in diabetes medicine. The cornerstone is good blood sugar management in order to minimize kidney, nerve and vision damage. It is also important to keep immunizations current and to control blood pressure and cholesterol. In a well-functioning team, the secretary can check to see if a patient has had his flu shot, the medical assistant can keep track of blood pressure, and the nurse clinicians can tweak insulin doses while coordinating food intake with the dietitian. By acting as the chief clinician, the physician can deliver better care to many more patients than he could if he were working alone.

The shortage of primary care physicians is forcing medicine to expand the notion of clinical teams beyond diabetes. The potential is for better care for more people.