Developing physicians as catalysts for change.
Failures in care coordination are a reflection of larger systemic shortcomings in communication and in physician engagement in shared team leadership. Traditional medical care and medical education neither focus on nor inspire responses to the challenges of coordinating care across episodes and sites. The authors suggest that the absence of attention to gaps in the continuum of care has led physicians to attempt to function as the glue that holds the health care system together. Further, medical students and residents have little opportunity to provide feedback on care processes and rarely receive the training and support they need to assess and suggest possible improvements.The authors argue that this absence of opportunity has driven cynicism, apathy, and burnout among physicians. They support a shift in culture and medical education such that students and residents are trained and inspired to act as catalysts who initiate and expedite positive changes. To become catalyst physicians, trainees require tools to partner with patients, staff, and faculty; training in implementing change; and the perception of this work as inherent to the role of the physician.The authors recommend that medical schools consider interprofessional training to be a necessary component of medical education and that future physicians be encouraged to grow in areas outside the "purely clinical" realm. They conclude that both physician catalysts and teamwork are essential for improving care coordination, reducing apathy and burnout, and supporting optimal patient outcomes.
Dr. George is a first-year resident, Family Medicine, Duke University Health System, Durham, North Carolina. Dr. Frush is professor of pediatrics, Duke University School of Medicine, clinical professor, Duke School of Nursing, and chief patient safety officer, Duke University Health System, Durham, North Carolina. Dr. Michener is professor and chair, Department of Community and Family Medicine, Duke University School of Medicine, and clinical professor, Duke School of Nursing, Durham, North Carolina.
Aaron E
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D003266:Continuity of Patient Care; D003479:Curriculum; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D004501:Education, Medical; D006801:Humans; D007857:Leadership; D015279:Organizational Culture; D010348:Patient Care Team; D010819:Physician's Role; D012017:Referral and Consultation