Health care has not always been identified as a team sport, as we’ve currently come to consider it. In the “good old days,” individuals were cared for by one all-knowing doctor who lived within the community, visited the home, and was available to attend to needs at any time of day or night. If nursing care was needed, it was frequently offered by family members, or in the case of a family of means, by a private-duty nurse who “lived in.” Although this brought in elements of teamwork, health care has changed extremely since then and the rate has quickened even more dramatically in the past two decades. The speed of change will continue to accelerate as both clinicians and patients merge new technologies into their management of wellness, illness, and complicated aging. The clinician working alone is now seen as unpleasant in health care—a lone ranger, a cowboy, a person who works long and hard to provide the care needed, but whose dependence on solitary resources and perspective may put the patient at risk.
A driving force behind health care practitioners’ transition from being soloists to individuals of an orchestra is the complexity of present health care, which is changing at a very high pace. The U.S. National Guideline Clearinghouse now lists over 2,700 clinical practice guidelines, and, every year, the results of more than 25,000 new clinical trials are published. No single individual can understand and use all this information. In order to benefit from the detailed information and specific knowledge needed for his or her health care, the typical Medicare beneficiary visits 2 primary care clinicians and 5 specialists per year, as well as providers of diagnostic, pharmacy, and other services. This figure is several times larger for people with multiple chronic conditions.
The implication of these acts is immeasurable. By one estimate, primary care physicians caring for Medicare patients are linked in the care of their patients to, on average, 229 other physicians yearly, to say nothing of the vital entanglement between physicians, nurses, physician assistants, advanced practice nurses, pharmacists, social workers, dieticians, technicians, administrators, and many more members of the team. With the rise in complexity in health care, which shows no signs of reversal, the number of connections among health care providers and patients will likely continue to increase and become more complicated. Data already suggest that referrals from primary care providers to specialists rose dramatically from 1999 to 2009.
Due to this complexity of information and interpersonal connections, it is not only hard for one clinician to provide care in isolation but also definitely harmful. As many clinicians provide care to the same patient or family, clinicians become a group working with at least one common aim: the best possible care—whether or not they acknowledge this fact. Each clinician relies upon information and action from other members of the team. Yet, without explicit acknowledgment and purposeful cultivation of the team, systematic inefficiencies and errors cannot be addressed and prevented. Now, more than ever, there is an obligation to strive for perfection in the science and practice of interprofessional team-based health care.