Support Network Newsletter Volume1, No. 9 August 4, 2016
We had two excellent talks this month. As you will see below, Carlene and Vicki like consumer input. If you wish to contribute to the ongoing discussion about improving health care, please email us and we will pass it on. To read the full newsletter click here.
Vicki Thomson: the Multidisciplinary Meeting
They’re the bane of our lives, terrifying and overwhelming and Vicki was here to explain why multidisciplinary meetings are the way they are.
She explained why they struggle to change them.
An MDM is used for many illnesses but it’s unusual to have patients attending. HNC patients attend these meetings because their cancers are visible and doctors gain by seeing the cancers in the flesh.
Who attends the MDM in Auckland?
The meetings are attended by patients and medical people from the four DHBs in our region: Northland. Counties Manukau, Waitemata and Auckland.
They can get referrals from other regions like Hawke's Bay or Waikato.
Private consultants also refer because most HNC cases should be discussed at an MDM.
The team at Auckland contains many different specialists.
If you're from out of town you might see the anaesthetist later in the day. A team of anesthetists come over to see to up to four patients.
Time to prepare
A radiologist looks at all imaging sent in again, even if has been looked at locally. A pathologist looks at all the slides obtained. (Some are even sent over from Rarotonga.) It’s reassuring to think that diagnosis does not depend on ONE person's knowledge. 
As well as the medical team, there is a large clerical team. The MDM coordinator would take 30 plus hours to arrange one meeting. For example asking for pathology slides takes work from clerical people in two locations. Posting or couriering these slides can take days. They need the physical slides on site well beforehand. It takes a week to get ready for a MDM.
Number of cases
Seven to 8 years ago there was no limit but now they can’t cope with the sheer numbers.
They can see only 10 cases from 8 am to 12 pm. Doctors have other responsibilities and have to move on.
As well as the ten patients they see, other patients’ routine 6-monthly scans and other issues are also discussed. They could discuss 30 - 40 extra people, as well as the ten who are seen.
Format
Patients get there at 8 am. Doctors start at 7.45 after their ward rounds or travel. Some patients arrive very distressed. Nurses sort out distress, smoking cessation, get a dietician to see them, organise pain control. Staggering patients’ appointments was tried but didn’t work.
When patients go into the room, they are confronted with about 15 faces looking at them. It’s very hard on patients, but one examination is now conducted that everyone can see and doctors can give feedback very quickly.
There is a booklet for patients. Esther will add our information to the back of the book.
Medical information continues to be an issue. Some people don't read the medical information. How much do we give and when? What format? It’s the same with information sheets on big surgeries. The other problem is that no two surgeries are the same.
When electronic health records are in place, Vicki believes that the delivery of patient information will get better. It will also be easier to care for patients when they can see records from Northland etc faster.
Surveillance Mode
There is a new initiative. After the first two years, the nurse specialists, Malveena, Felix and Vicki, will see patients during their clinic visits. They have to get smarter. They now have more patients and not enough doctors. 
Patients don’t like the endoscope procedure. Vicki said in general they try to spray people earlier so the anesthetic works. They spray people before the MDM and in the ward they are training house surgeons to go around and spray people before the doctors come.
National Collaboration
Over the last 15 years since the introduction of DHBs in 2001, each area has done its own thing. Now there is a movement towards a more global approach with the MoH providing National Standards. There is now a time frame from government. For example, after seeing your GP with a cancer, you should be seen by a specialist within 14 days. After the decision to treat, only 31 days should elapse.
Educating GPs
Sometimes they do not raise enough of a red flag. For example, writing “has had sore throat for 2 weeks” is not enough info. If you don’t trust your GP, change your GP. Once again, electronic health records and perhaps visual images will help.
Contact person at hospital
One patient raised the question of who to ring when someone is in surgery all day. Vicki said,
“In all circumstances the best person to contact is your nurse care coordinator- the number will be provided to you as you are treated. If not please feel free to ask. Most time the nurse is able to access in some way or another, the doctor in surgery if needed urgently. Otherwise they will discuss the issue with the relevant doctor probably the next morning.”
MJ.
