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Multi-discplinary Meetings

Multidisciplinary meetings, those panels we front up to after diagnosis. A room full of doctors and other health professionals who are going to decide our treatment and hence our fate. I've been to two: in the first there was a semi-circle of clinicians standing around the edges of the room and my husband and I sat in the front. Four years later I sat on a platform by myself while the "audience" sat in seats in front of me and, I think, looked at a screen of my results. I was literally crossing my fingers and watching bemused while a nurse patted my shell-shocked son on the back.

Appearing in front of a panel like this is not the norm in other countries or for other cancers. Some people hate the idea. I quite liked it because I figured I'd get the best chance of good treatment if people could actually see and feel my lesion and discuss it afterwards. I think there could be better practices after the meeting. I'd like to know more about why certain decisions are made, but I feel it is a unique opportunity to be seen. What do you think?  Below is a definition of the meeting.

multidisciplinary team meeting is a deliberate, regular, face-to-face (or videoconference) meeting involving a range of health professionals with expertise in the diagnosis and management of cancer. The purpose of the meeting is to facilitate best practice management of all patients with cancer.

https://www.centralcancernetwork.org.nz/file/fileid/18174

Following is a summary of a Auckland Support Meeting in 2016 when clinical nurse specialist talked to us about MDMs. 

Multidisciplinary Meetings. 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 b 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 BoP, 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. 

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.

 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.

Sadly, we have had at least two patients in our network, in different parts of New Zealand, who have made the long trip to go to the multidisciplinary meeting, full of hope that a treatment plan would be drawn up, only to be disappointed. Their appearance before the panel was cancelled because of health issues. They were not aware that these issues disqualified them from the meeting and felt let down. A double whammy: no treatment and no warning that they would not appear before the panel but would be seen by one or two doctors to one side or after the meeting. There might be good reasons for the cancellation but from the patients point of view this is very hurtful, even humiliating. 

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