Written by Kristine Hamman
To kick off the Vet Rehab Summit Qualifiers, we chatted to Farrier, Yogi Sharp, and Equine Physiotherapist, Gillian Tabor, about their approach to ‘getting it right’ when it comes to the multidisciplinary team approach.
The primary obstruction to an effective MDT is effective communication. We discuss why communication is a challenge, how we can overcome it, and some practical solutions to apply to our practices and professional relationships.
Below is a culmination of our discussion:
The Multidisciplinary team
When seeing a patient for the first time, there is a great deal that we need to ask, look at and assess to get a well rounded picture of the patient’s condition. A big part of this initial evaluation, is to connect with and speak to the other professionals involved in the care of the patient. This could include the veterinarian and veterinary rehabilitation therapists, but could also include in the equine industry, the saddle fitter, farrier, bridle fitter, trainer, and yard management and staff. In the canine industry, Donna Sidebotham shares that we could be working with a behaviourist, hydrotherapist, acupuncturist, holistic vet or other alternative medicine practitioners.
Knowing who the other members of the team are and then connecting with them, is an essential step in providing the optimal long term care for the patient. Consider your patient as a puzzle. Each member of the team, owner included, will have or find one or two pieces of the puzzle. When we bring all the members of the team together in an open, non-judgemental discussion, we can bring these pieces together and clearly see and understand what the patient is dealing with. If we choose to work alone, it may take us a much longer time, it at all, to find and connect all the pieces of the puzzle that will allow us to make the greatest change in the patient’s life.
Communication: the primary challenge
Although speaking to all these other professionals is what should be done, it is not always easy. Throughout the discussion with Yogi and Gillian, communication was the number one problem highlighted; whether this was a lack of communication, unclear communication or miscommunication.
Gillian Tabor highlights an incidence of miscommunication from her experience. She shared with a client that their horse was in pain, and that they should call the veterinarian out for an assessment. The owner then called the veterinarian, and told them that Gillian suggested that the Vet prescribe Bute to the horse. Gillian, having a relationship with the Veterinarian, called them on her way out of the yard – by this time the owner had already been in touch and related her message! You can well imagine the conversation that followed between Gillian and the Veterinarian. The fact that they had an established working relationship was a huge benefit in this case, and likely smoothed over a potentially ‘prickly’ situation.
Developing the skill
In order to avoid miscommunications and misunderstandings, we need to learn to communicate effectively, which is not something that comes naturally to us. Communication is something we need to learn and develop; it is a skill we need to train in ourselves. We can improve this skill through continuing education, which will help us not only to understand the role of another professional so that we know when to call the vet vs the saddle fitter, but also teaches us how to effectively communicate, whether it’s sending a vet report or picking up the phone and making a call.
When we look within the context of the MDT, our first goal should always be to develop and build relationships. This means getting to know someone, trusting someone and being open to questions and being curious about what the other person knows and how much they want to work with us. It takes asking them whether we can spend time with them and giving as we would with any other relationship. This process will take time but will be worth it in the end when we have a team around us that we can trust and have open discussions with.
The owner will ultimately choose who forms a part of their team and this will inevitably be based on who they trust; we will need to work within their decision and build relationships within that structure, so it is vital that we learn to communicate effectively, even when the team is not one of our choosing.
Developing an objective language
Yogi suggests that the most effective way to build strong channels of communication, is to have an objective language that everyone understands. This allows us to present facts and information instead of opinion and thought, establishing a tone of discussion without creating feelings of criticism or blame.
This idea agrees with Nicole Rombach’s suggestion of coding our collected data. When we assign a number to the palpable pain, or a measurement to the degree of lordosis present, this removes the bias and judgement and makes it much easier to communicate with all members of the team.
This effective communication will also require us to learn aspects of and deepen our understanding of the other’s jobs. Being able to effectively identify problems in a specific field (saddle fit or hoof balance for example), without sounding like we know better than the person we are referring the patient and client to.
It comes down to us maintaining our professionalism and to staying as objective as possible, keeping open lines of communication and avoiding the blame game. If we don’t agree with someone in the group, keep an open mind as we may not know it all and try to see where they are coming from. It is better to work through a disagreement than to push a member of the team out, which will result in a breakdown in relationship and difficulty working with them in the future.
The additional load of fostering the MDT
In order for us to achieve this ‘communal’, objective language and to develop these open lines of communication we need to be sending regular reports, not just to whoever referred the client to us but to all the members of a particular team. This brings with it the challenge of an added admin load which often goes beyond our time charged. So how do we manage this?
A point of reflection may be that we charge for the value of our service rather than our time and explaining to a client that they are not just paying for the time present but for everything that is required (including reports etc) in order to get the best outcome for the patient.
We could also explore time-saving platforms such as a WhatsApp groups for each patient that includes each of the involved team members, in order to quickly relay thoughts, findings and treatment plans. That being said, it is important to find out in which ways other professionals would like to have information communicated to them. Whatever method is chosen, it needs to be time and cost-effective and allow us to pass on what is applicable to that professional without them needing to sift through our report for the content which applies to them.
Developing our skills of communication is something we will never stop doing. It is only through communication that we can build trust, and with trust it will be possible for us to discuss challenging cases with more tolerance and understanding. Although this is not something we are naturally good at, it is something we must be willing to work at if we want to work well within the multi-disciplinary team and so that we can do our job with excellence, providing the best possible care to each of our patients.
You can watch this recorded panel discussion in your Onlinepethealth Members portal, or in the Onlinepethealth Free Zone.