Boundaries, gaps, and overlaps: defining roles in a multidisciplinary nephrology clinic

Abstract

Terese Stenfors-Hayes,1 Helen H Kang2 1Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; 2BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Abstract: This study aims to explore how health care professionals in a multidisciplinary chronic kidney disease clinic interact with one another, patients, families, and caregivers to expand understanding of how this increasingly common form of chronic disease management functions in situ. Nonparticipatory observations were conducted of 64 consultations between patients and health care professionals and end-of-day rounds at a multidisciplinary chronic kidney disease clinic. Key themes in our findings revolved around the question of boundaries between the health professions that were expected to work cooperatively within the clinic, between medical specialties in the management of complex patients, and between caregivers and patients. Understanding the importance of various professional roles and how they are allocated, either formally as part of care design or organically as a clinical routine, may help us understand how multidisciplinary care teams function in real life and help us identify gaps in practice. This study highlights two areas for further study and reflection: the effect of discrepancies in health information and the role of caregivers in patient care. Keywords: clinical medicine, interprofessional relations, observation, qualitative research