Questions that often arise in clinical situations involving multiple providers and participants include:
- Who among the involved medical professionals is expected to bring clinical information to the treatment team’s attention?
- Who makes sure that all those involved in the case — including the patient and family — understand what information and technical measures are needed at each point in the work?
- Who is expected to take responsibility for keeping the clinical process moving along productively?
- When there is a stalemate who should take the lead in making decisions?
The Medical-Psychiatric Coordinating Physician (MPCP) role is specifically designed to address these issues. Including an MPCP in a multi-person treatment results in more methodical collection and use of data, the assurance that an integrated treatment plan will be created and implemented, ongoing collaboration between treatment team members, and the consistent involvement of patient and family.
Following an assessment that includes a detailed history and medical-psychiatric examination, the MPCP:
- Repeatedly deconstructs the complexity of the clinical situation, identifying and prioritizing its components.
- Develops and initiates a treatment plan in collaboration with all team members, including the patient and his or her family.
- Selects and prioritizes the clinical aspects to focus on at each point as the case progresses.
- Recruits and coordinates team members, integrating each one’s contribution with the treatment strategy.
- Monitors progress using formal outcome measures that are set at the beginning of the case and modified over time.
- Continually integrates new clinical findings and information from the medical literature into the treatment plan, in part through collaboration with team members.
- Routinely applies “truing measures”* for assessing and directing the work of individual team members and the team collectively.
- Finally, the MPCP delivers some of the patient’s direct care, for example, in the form of medication management or psychotherapy, if the MPCP is a psychiatrist.
The outcome of this process is improved diagnosis and treatment that is focused and monitored to assure that treatment goals are being met.
The MPCP fills a different role from that of the typical non-physician medical team coordinator by putting a physician with expertise in systemic medicine and psychiatry, as well as the interface of the two, in the leadership position. The complex clinical situations targeted by the MPCP method are often remarkably complicated, both personally and technically. Psychological, psychosocial, and treatment parameters constantly change, mandating repeated, and often urgent, revisions of treatment strategy and plan.
* Truing measures are the assessments and diagnostic procedures, including clinical examinations and laboratory tests, that physicians use to guide them toward clinical accuracy, in effect toward clinical “truth.” For individual physician team members, truing instruments include diagnostic procedures unique to their specialty, e.g., radiological procedures. For the MPCP, truing mainly involves setting outcome measures (identifying goals) and making sure they are achieved by members of the treatment team.