“If it were easy, this session would not be here.” These are the words of Jens Ricke (University Hospital Munich, Munich, Germany), who drew attention to the self-evident nature of the difficulties involved in multidisciplinary collaboration during an expert roundtable discussion at the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) annual meeting (10–14 September, Barcelona, Spain). Titled ‘If you are not at the table, you will be on the menu’, the discussion participants, who presented perspectives on multidisciplinary work from their various societies, kept returning in the subsequent question and answer section of the session to one key message. They underlined that while vying to make your voice heard at multidisciplinary team meetings is vital, this should not be motivated by ego, rather, by the common goal of what is best for the patient based on clinical effectiveness and patient outcome.
Raman Uberoi (John Radcliffe Hospital, Oxford, UK) began the discussion with a question for vascular surgeon Eric Verhoeven (General Hospital Nuernberg, Paracelsus Medical University Nuernberg, Nuernberg, Germany) and Stefan Müller-Hülsbeck (Academic Hospitals Flensburg, Flensburg, Germany) on the “stresses and strains” that arise from multidisciplinary collaboration. “You have both made the point that we ‘forget patients’—how much do you think that is driven by egos?” Verhoeven was first to acknowledge that a little bit of ego may not be a bad thing, pointing out that “without that [type of] personality”, it can be difficult to convey your specialist perspective effectively and persuasively. He recounted how he was able to influence the clinical setup at his hospital, so as to have “the whole personnel working together in the same location”—this includes radiologists, vascular surgeons, and nurses and technicians specially trained in radiology and endovascular techniques. Emphasising the “big benefit” this approach affords their patient-centric service, Verhoeven went on to share how they have a daily “vascular patient meeting”—even the name puts the focus on the patient, as opposed to the interdisciplinary makeup of the clinical team behind the care.
Müller-Hülsbeck picked up the discussion to label this multidisciplinary way of working as “an ideal playground”, which should be harnessed to “put the patient first”. Collaboration can yield highly successful outcomes, which, at Müller-Hülsbeck’s centre, takes the following form: “if we need, for certain reasons, surgical cutdown, we call the vascular surgeon, and vice versa, if they need help from the interventional radiologist”. This collaborative way of operating is how they go about treating thoracic and abdominal aneurysms in Nuernberg and Flensburg, delegates heard, with a strong emphasis on “speaking a clear language” to facilitate cross-specialty communication for the benefit of the patient.
Part of this clarity when communicating, Müller-Hülsbeck detailed, is establishing “clear rules that are defined in advance”. This is so that the answer to the question of “who does what with the patient?” is not dictated by egos, or other factors that may render patient outcome a secondary consideration. In contrast, Verhoeven relayed how, at his hospital, “it is completely irrelevant who is doing what”, elaborating on this to say that “we decide together as a team who is the best suited” for taking on each individual case. This statement then gave way to Ricke making the point that different people’s definitions of collaboration will be different, and that what multidisciplinary involvement looks like in a particular hospital needs to be defined— ‘involved’ does not necessarily mean doing the procedure, as he added that it could mean only taking part in decision-making beforehand.
In addition to keeping the patient at the forefront of a procedure and “[putting] ego aside”, as Valérie Vilgrain (Assistance Publique-Hôpitaux de Paris, Paris, France) drove home in her presentation, Ricke summed up another takeaway from the session as a whole: “What I have learned today is that we need communication training in medical school.” He went on to contextualise this by making clear that “Nuernberg is not the rule” and that collaboration may not occur in a multidisciplinary manner as effectively in other hospitals. His hope, therefore, is that by starting early, the next generation of clinicians can learn while still at medical school to communicate in a way that is conducive to collaborative, yet patient-centred work.
Antonin Krajina (Charles University Hospital, Hradec Kralove, Czechia) then called upon the societies, such as those represented round the discussion table, to “take responsibility for interdisciplinary education.” Examples of this already occurring were heralded throughout the session, including the European Society for Minimally Invasive Neurological Therapy’s (ESMINT) theoretical stroke course (EXMINT).
Stroke treatment and by whom it is delivered formed a further part of discussion during the session, with the panel shining a light on the differences in stroke thrombectomy services between the UK and The Netherlands in particular. Beyond the theory, as courses such as EXMINT teach, there is a question of how much training an interventionalist should be required to do before they can independently carry out thrombectomies for stroke patients. Wim van Zwam (Maastricht University Medical Center, Maastricht, The Netherlands) explained how “in The Netherlands, we have a requirement that if you want to do thrombectomies, you have to do at least 25 under the guidance of an experienced interventionalist, and your centre has to do at least 50 thrombectomies per year. These are very simple and straightforward guidelines.” However, Van Zwam acknowledged that, while there are more centres that can and want to do stroke thrombectomy than the country needs in The Netherlands, such is not the case in the UK. Uberoi labelled the latter as a “chicken and egg situation”, whereby “until you start doing the procedure, how can you have enough cases to train in it.”
Van Zwam followed up to ask whether a solution could be to allow adequately trained cardiologists to perform stroke thrombectomy, to which Uberoi responded: “I do not really think the patients care who does their procedure], as long as it gets done and it is a safe service. Ultimately, you want the best trained person, but there has got to be a reality check in terms of what is achievable. Do you want zero service, or could a ‘silver’ or ‘bronze’ service be good enough to improve outcomes without compromising safety? That is the kind of balance I feel we need to look at in the UK.”
The session closed with all participants agreeing that “the clinical aspects of patient care are the same whether you are a vascular surgeon, interventional cardiologist or interventional radiologist.” This can, therefore, be a unifying motivation in multidisciplinary collaboration scenarios, and, as Vilgrain summarised, “we are better doctors when we work together”. This necessitates leaving egos at the door and working communication skills into education for medical students and trainees.
