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Education Schedule - January 2016 (PDF)  

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Nurok, Gewertz Back Team-Directed Care

Nurok Michael

Michael Nurok, MD, PhD

Gewertz Bruce

Bruce Gewertz, MD

In a recent issue of JAMA Surgery, Michael Nurok, MD, PhD, and Bruce L. Gewertz, MD, advocate for a more team-based model of medical care in modern hospitals.

The two present their viewpoint that the decades-old "captain of the ship" doctrine — which says that the supervising physician is solely responsible for patient care — is inconsistent with today's multidisciplinary, team-based approach to care. They conclude that having a single doctor in command of all elements of care may actually impede good patient management.

Nurok, medical director of the Cedars-Sinai Cardiac-Surgical Intensive Care Unit, and Gewertz, surgeon-in-chief and vice president of Cedars-Sinai Interventional Services, take note of the changing nature of medical care to underscore their point of view. It is evident that procedures have become more complex and that the patients undergoing them often are sicker than in previous eras, they write; as a consequence, a greater number of specialist physicians and ancillary providers are involved in major elements of care. This combination necessitates an approach to care management that favors teamwork, communication and consensus-building.

Nurok and Gewertz also write about other advantages of a collegial, nonhierarchical approach to patient management and steps hospital leadership should take to make team-based, coordinated care the norm. Recommendations include facilitating and incentivizing effective teamwork as well as designing administrative and physical structures that support outstanding, team-driven outcomes.

Nicholas Sadovnikoff, MD, co-director of Brigham and Women's Hospital Surgical Intensive Care Unit, also contributed to the JAMA Surgery "Viewpoint" article.