Comparison in attitudes towards team decision-making strategies between medical and surgical clinicians
| Surgical clinicians | Other clinicians (gastroenterology and nurse endoscopists) |
| Positive attitudes | |
| ‘I voluntarily go to the MDT but it’s not part of my job plan. I’ve been going to it because I think it’s good to see cases and to see also the outcome of the cases I have done.’ (Participant 15) ‘And then if they are happy (the polyp MDT) they will get the patient across and bring them straight for colonoscopy with procedure. So that they do it quite quickly.’ (Participant 9) ‘All of us have our own niche within that MDT. We work with people who do TEMS and we have somebody who is interested in ESD. There are cases which are debated sometimes but I think it works quite well.’ (Participant 1) ‘Before that (complex polyp MDT) it was hit and miss and whoever can do it, can do it kind of thing.’ (Participant 4) | ‘I feel very comfortable I’ve got that (polyp MDT) around me. It’s quite secure and I’d find life a more vulnerable and scarier if I had to make decisions myself.’ (Participant 3) ‘I’ve got complete oversight of when all these patients are booked. We cross-reference every patient that’s discussed in a complex polyp meeting with my database waiting list…… I can see at any one time how many patients are waiting to be dated and when their scope is going to be.’ (Participant 2) ‘Now they are discussed in MDTs and we will make sure they are done by an appropriate endoscopist.’ (Participant 5) ‘There is now a really good process that the screening nurse fills in the referral and we get written feedback from the MDT. It’s not just education about what the patient’s management would be, but also education about what I’ve done and whether I’ve done the right things or not.’ (Participant 3) ‘We would never send any polyps to the surgeons without having discussed in the complex polyp MDT, and our surgeons are part of that MDT as well.’ (Participant 17) ‘That’s one of the things you pick up from MDT so that that lesion can be thoroughly seen by anybody and there is no need for them to be scoped again.’ (Participant 3) ‘I found an enormous polyp about 2 weeks ago what I considered not to be endoscopically resectable but the opinion of my colleagues was the opposite.’ (Participant 14) ‘I think it’s a great service and gone from strength to strength over the past couple of years. I run it alongside the gastro fellows and it’s really well attended. There’s lots of buy-in from both the surgical and the gastro teams in terms of referring patients along that pathway to the complex polyp MDT.’ (Participant 15) |
| Negative attitudes | |
| ‘The complex rectal lesion MDT is probably the most challenged pathway in the trust because we have quite long waits. We only do the meeting once a fortnight and it does mean that it’s logistically quite difficult.’ (Participant 15) ‘We will say let’s refer to the complex polyp team, but it overloads that service.’ (Participant 9) ‘We need people who have got the time to properly participate in the MDT. Ours is the same day as our colorectal MDT, so we do find that people are torn between the two and it’s sometimes difficult to attend the whole meeting.’ (Participant 15) | ‘Often you get a letter (to the MDT) and there’s not even a size mentioned. The admin team then end up chasing the consultant. You don’t want some communication going amiss and then a patient suffering. I try to encourage my own admin staff to try and chase things up rather than sending letters back and forth just creating delays.’ (Participant 12) ‘The original time slot is now inadequate, and it often impacts on the gastro meetings that follow straight after. It’s not that people aren’t getting done, but it’s impacting on other meetings in the morning.’ (Participant 18) |
ESD, endoscopic submucosal dissection; MDT, multidisciplinary team.