MDT

In mental health we're all pretty familiar with working within a multidisciplinary team (MDT) which generally is A Good Thing.

Our patients have input from medical, nursing, social work, pharmacy, occupational therapy and CBT directly from our team with additional access to physiotherapy and psychology from the service. We've good links for dietetic, epileptic, continence, diabetic and stroke rehab input.

Thus when we see a patient we're usually in a position to do something effective, as a team. Too, we support one another with both clinical advice and through stress and strife.

In my junior doctor training when sitting through a Forensic Psychiatry lecture (in the days when we were thankfully allowed to be spoon fed in lectures) the content became increasingly macabre, including blood splattered rooms and body parts. When the lecturer was challenged by one gentle soul that this was gratuitous and unnecessary for the teaching he replied with wisdom. "Psychiatry is about misery. If you don't like it, you're in the wrong field."

Much of psychiatry is, I suppose, "about misery" as he meant it. People who are well and satisfied and happy and coping won't have much involvement with mental health services. Although I think "misery" is over stating it, most patients and families are experiencing marked distress. Since we're not in a position to cure most folk, we're mostly in the business of helping people make sense of and cope with their situations better.

For folk working in this field, dealing with people in distressing hour after hour, day after day, can be invigorating (as so much good is done) or demoralising (as few folk are cured and the morbidity never seems to end). In places where mental health services are upbeat, motivated, zealous, patient centred, compassionate and healthy (Law 4 : The patient is the one with the disease) the difference is the team.

A supportive and open MDT than has good team dynamics makes a world of difference to the culture we work in and therefore the type of work we do and indeed the details of the way we work.

Curiously, days go by without me seeing another Consultant colleague, weeks go by without me chatting to one. They're there when I'm worrying I'm having a blonde moment and need to bounce an idea off them, but by and large the MDT challenges and supports me such that practice is as it should be.

Now that's an interesting position for me to reflect upon, when senior nurse practitioners working collaboratively with medics help generate such a dynamic.