Medical dominance in multidisciplinary teamwork: a case study of discharge decision-making in a geriatric assessment unit.
OBJECTIVE
To investigate the degree of medical dominance in multidisciplinary teams in a geriatric assessment unit by focusing on decision-making with regard to patient discharge.


BACKGROUND
The persistence of medical dominance in multidisciplinary teamwork has been widely assumed but insufficiently researched, particularly through close observation of team practice. The present study seeks to rectify this by examining the extent of medical dominance in two multidisciplinary teams working in a hospital-based geriatric assessment unit.


METHODS
Team practice was analysed by observing and audiotaping five case review meetings in each team and by semi-structured interviews with team members.


RESULTS
In terms of level of contribution, the issues raised at meetings, and the team responses to discharge initiation, a lower than expected level of medical dominance was identified. This lower than expected level is related to consultants' views on the nature of rehabilitation, leading to a consensus amongst team members as to the purpose of geriatric assessment, and to a high level of team stability.


CONCLUSIONS
Reducing the level of medical dominance encourages the contributions of all team members and thus enhances patient care. More training in team skills would also be beneficial, including interprofessional training.
Gair
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G
Queen Margaret University College, 36 Clerwood Terrace, Edinburgh, Scotland, UK.
Hartery
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T
D000368:Aged; D003659:Decision Making, Organizational; D015577:Geriatric Assessment; D006757:Hospital Units; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008505:Medical Staff, Hospital; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D010819:Physician's Role; D011209:Power, Psychological; D017009:Professional Autonomy; D012606:Scotland