Interprofessional Collaboration Revisited
Do people who have no professional titles – many patients may fall in this group – feel sidelined by the enthusiasm for ‘inter-professional collaboration’? What happens if you’re not a ‘professional’? Or what happens if you are a ‘professional’, or were trained as one once, but you’re now ‘just a patient’, or a caregiver, or a retiree, or you’re at home with the children, or you’re unemployed?
Healthcare was early to jump on the word ‘professional’. Among the earliest references to the word ‘professional’ – a person who engages in a specified occupation for money, rather than as a pastime – comes from Robert Chambers, writing in the 1st Volume of the Domestic Annals of Scotland (“two professional clengers…that they might deal with an infection which had fallen forth”). (A ‘clenger’ is akin to a ‘cleanser,’ and is a designation, I understand, much used in witchery).
Despite its well-documented benefits for the quality and integration of care, one could argue that the very language of inter-professional collaboration for patient-centred care can be exclusionary. It assumes that you need to be a professional to have something of relevance to contribute. It further presumes the very concept of professionalism will endure, which is highly doubtful, given cultural and economic trends. These two assumptions, I find, are particularly pronounced in Canada. At a downtown Toronto cocktail party, tell people you were trained as a lawyer or an accountant or a nurse, and people will then ask what ‘organization’ you’re with. (Say the same thing in Houston or Haifa and people tend to ask what business or trade you’re now in.) We Canadians have a special inclination toward dividing the world up into professional ‘company men or women’ and non-professional nomads.
E-patient and author Trisha Torrey advised me that one solution to the exclusionary nature of the word ‘professional’ is to expand its definition to include patients. She explains: “When it comes to my body, I am the consummate, longest-standing professional. I am the person who has lived in it for the entire time it has been alive. I am the person with the most knowledge about what does, or doesn’t, feel right to me – so that makes me a professional, too.” (She expands on similar notions in her important new book, “You Bet Your Life! The 10 Mistakes Every Patient Makes”).
If the term ‘professional’ includes patients, then it is a word without special occupational status, and we all emerge as peers – and individuals. As wise e-patient Jen McCabe explained to me, the term ‘professional’ “connotes someone who belongs to part of a work/functional oriented group.” By contrast, she observes, “a personal identity or ‘empirical’ professional, or individual (a patient, caregiver, etc) is by default an ‘n of 1’.” (Thanks to Jen for alerting me to the difference between personal and professional identities contained in the ‘e-Patient Manifesto,’ which you can access here).
It seems to me that in healthcare there are now two camps: people (generally over 35) who advocate for expanding the number and reach of regulated professions – in health and other sectors – and then there are those (generally under 35) who consider themselves private citizens or patients first, no matter their professional pedigree. For this latter group, acknowledging ‘professionalism’ can create conflict and artificial boundaries. It assumes that only professionals are informed by data (engineers) and biological evidence (health) and precedent (law) and numbers (accountants).
Have no doubt: Those who advance the higher mission of ‘inter-professional collaboration’ are on the side of the angels. In the interests of holistic and sensitive patient care, it is far better that we bring professionals together than hive them apart, or, worse, buttress a hierarchy that puts doctors in the pitcher’s mound, and pushes other professionals into the outfield. Meanwhile, non-professionals are mere onlookers.
My view is that inter-professional collaboration will soon be displaced by peer-to-peer collaboration. This is happening already, as e-patients and patient groups rise in power and assert new legal rights: rights to own their data; rights to engage in joint-decision making; and rights to become full-fledged members of the care team. This may threaten a subset of powerful professionals. As Lord Melbourne (Paul Bettany) in the film The Young Victoria tells the plotting Sir John Conroy (Mark Strong) and the Duchess of Kent (Miranda Richardson): That game has been played, and it has been lost.
About the Author(s)
Neil Seeman is a writer, and Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College at the University of Toronto.
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