Assessment as a multidisciplinary activity

Multidisciplinary teams can take may forms, varying from the tightly organized and necessarily hierarchical surgical theatre team in which the role of each member is clearly defined and unchanging, to loosely knit groups in other types of health service in which only some of those attending meetings about patients regard what is taking place as a team event. For the purposes of discussion of the types of multidisciplinary teamwork increasingly to be found in the mental health services, it is useful to differentiate between multidisciplinary practice, familiar to many generations of mental health workers, and the more recently evolved multidisciplinary teamwork. Both of these styles of work have many variations, but they both have some key features that need to be recognized by those involved.

In multidisciplinary practice the consultant or most senior doctor present at clinical meetings or 'ward rounds' is accepted by all as the leader of the group, and listens to (and usually depends upon) the views of the senior nurses and other health professionals who may or may not be present. But the decisions about treatment and management are clearly acknowledged to be the responsibility of the doctors present. In most settings the only essential attendees at these meetings are the doctors and nurses; attendance of other health professionals is usually welcomed and valued, but they are not regarded as necessary members of the group.

Multidisciplinary teamwork has probably developed in response to a marked increase in the numbers of social workers, occupational therapists, clinical psychologists, and others, in those medical services in which patients and families with multiple needs are the rule rather than the exception. Clinical skills and techniques that were not previously available are now available, and the health professionals offering these expect quite naturally to be given increased personal and professional recognition; this can usually be found as a member of a multidisciplinary team of the sort described here. The most fully developed style of multidisciplinary teamwork involves a very significant commitment of professional time by each member so that all the team meetings can be attended, in addition to the time spent directly with the patient and family.

Some sharing of responsibilities and blurring of roles is needed, but each member also must be seen as retaining the professional skills of their parent discipline. Role blurring is most obvious in the information-gathering and information-sharing phases of assessment, and in the team discussions that lead to agreement about the content of a care programme.

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