Multidisciplinary teamwork is increasingly becoming a buzz phrase in medicine, but for good reason. Traditionally as specialists, we get taught to be competent in specific areas and unfortunately sometimes lose sight of the bigger picture and the role other disciplines may play in treating our patients. We end up putting ourselves at the centre with patients moving around us when we realise we can’t help. This means that when we see a patient with a problem we initially believe we have all the skills needed to solve that problem. That might very well be the case with simple problems but we all know that medicine isn’t always simple. And cancer certainly is not. The proposed solution is putting the patient at the centre and healthcare professionals working in a multidisciplinary team together to solve the problem. 

In order to manage complex problems like cancers we have to think about what’s important to the patient. The head and neck is a very social disease, meaning that it affects how we interact with others. Our appearance, how we talk, chew and swallow are critical in good quality of life. We don’t realise that until we lose it. 

Putting patients at the centre means finding out what their values are and what is important to them. Our goal as a team is to help them achieve their goals during the difficult cancer fight. Cure may not always be the goal. Most often though it is the primary goal. Other important goals include making sure the cancer doesn’t come back and maintaining as high a quality of life as possible. 

Shared decision making in a diverse yet inclusive team of passionate and competent professionals who meet often, has proven to get the best outcomes in a cost effective way. This model had been written about extensively by people like Michael Porter for the Harvard Business Review.

In practical terms this means we use as much information as possible in the form of investigations to recommend treatment that has the best chance of cure. We also think of all the ways treating a patient with head and neck cancer can impact their life, and implement measures before treatment to minimise problems after treatment. This may include better nutrition to improve the patient’s resilience, dealing with problem teeth beforehand or undergoing swallow therapy. This can be frustrating for patients because they want to start treatment and seeing other professionals implies further costs and can be time consuming, but pre-treatment intervention has proven to be valuable time and time again. 

The members of a good multidisciplinary head and neck cancer team are head and neck surgeons, reconstructive surgeons, radiation oncologists, medical oncologists, radiologists, nuclear physicians, endocrinologists, pathologists, anaesthesiologists, physicians and intensivists, a dental team including a maxillofacial surgeons, prosthodontists and oral hygienists, speech and swallow therapists, nutritionists, physiotherapists, psychologists, social workers, and palliative care physicians.

At Mediclinic Morningside we all meet every Friday morning, currently still virtually.