The Need for Multidisciplinary Medicine

Gone are the days of the giants of medicine who could master everything. There used to be a time when the undifferentiated physician could do it all - deliver babies, look at urine specimens under the microscope, perform an appendectomy, diagnose pneumonia, administer sedation. But modern medicine is too complex, too big, too nuanced for anybody to know everything in it. We spend years training in residency to become proficient in knowledge in our one small field, surrendering to the fact that we won't be generalists anymore.

I became very aware of this working with surgeons in the CVICU. I have a great respect for cardiothoracic surgeons. They not only master the technical skills involved and perform long, high-intensity operations, but they also have a good knowledge of cardiovascular medicine. Surgeons can look at echocardiograms, understand pathophysiology of disease states, manage pressors. But, I realized, this is not their focus. Surgeons alone cannot run the unit.

As an anesthesiologist, I spend the bulk of my time pondering vasopressors, echocardiograms, physiology, and pharmacology. While the surgeons make delicate decisions about where to cannulate the aorta, I am experimenting with, learning, and understanding the medical management of these patients. In the CVICU and particularly with complex patients, a multidisciplinary approach is absolutely necessary. The surgeon knows exactly what the operation entailed, but his decisions about vasopressor or ventilator management won't be as nuanced as mine. Likewise, I can manage coagulopathy, but if the bleeding is a surgical vessel that needs to be clipped or tamponade that needs to be evacuated, I can do nothing.

Over the month on the CVICU, I learned to trust my training, instincts, and judgment. I've learned the value of the team, of keeping everyone on the same page, of listening to each person's input, and of taking that person's background and training into account. None of us can be masters of everything, and patients benefit most when experts in different areas collaborate.