An MN&B BB…

Doctors love acronyms; they use them all the time. They’re bad enough when they’re talking:

• “What did the patients FBC, U&Es and CRP show?” – translated as “What were the results of the fancy blood tests we sent to the haematology and biochemistry labs?”
• “The patient grew a CNS” – translated as “the bacterium in the patient’s blood was a coagulase negative staphylococcus (a skin contaminant)”
• “The patient is on AMG” – a personal pet hate this one, translated as “the patient has been given the antibiotics Amoxicillin, Metronidazole and Gentamicin”

​Doctors get even worse when they write things down with acronyms, although this is probably because their writing is atrocious so they might as well print the acronym, and they don’t want to admit they can’t spell most of the words!

• The Pt was CO SOB – the patient was complaining of shortness of breath
• The CXR showed LLL consolidation – the chest x-ray showed left lower lobe consolidation
• d/w Sx for USS then review on w/r – discussed with the surgeons who would like the patient to have an ultrasound before they review on their ward round!

 
It’s almost like a secret code only for those “in the know”, and maybe that’s another reasons doctors do it… they want to keep the mystery of it all…
 
I’m not a big fan of acronyms, I think they can lead to confusion a lot of the time, but I do still use them a lot I have to admit. However, there is a TLA (sorry… that’s a three-letter acronym 😊) I do like, and that’s an MDT.
 
What is an MDT?
MDT stands for multidisciplinary team.
 
An MDT is a group of different clinical staff coming together to discuss and plan patient care. Any clinical staff can be part of an MDT not just doctors, but also nurses, physiotherapists, pharmacists, occupational therapists (shortened to OTs!?) and speech and languages therapists (SALT!!!!!) to name some.
 
In these meetings all aspects of the patient’s care is discussed, plans are made of how to proceed, and notes are amended to reflect the outcome. A member of the team will have discussed options with the patient before hand if they are already known to the team, or a team member will talk to the patient after the initial discussion if they are new patients.
 
Often MDT meetings are formal meetings where everyone sits in a room (or now on Microsoft Teams) but sometimes they are more informal and take the form of ward rounds meeting at the patient’s bedside. Both are good and the choice depends on the purpose of the meeting.
 
Types of MDT
The most common, and probably the original, type of MDT was known as the cancer MDT. Not a nice name really but the purpose was to bring all of the specialist involved in cancer care together to agree how to investigate, plan chemotherapy, organise social support, admissions etc. for patients. It was much easier to do this regularly in a planned way than to get everyone together at short notice every time a new patient came in.
 
Since the original cancer MDTs, other types of MDTs have started. There are “lung MDTs” to discuss the management of complex lung conditions, “orthopaedic MDTs” to discuss the surgical and post operative needs of patients requiring joint replacements, “frailty MDTs” to discuss the complex needs of elderly or frail patients.
 
I am a member of a number of MDTs, and I really enjoy being a part of them. My role is to advise on investigations for possible infections, arrange for further laboratory tests and suggest possible treatment options for the patients.  Some of my MDTs are listed below with the other members of the MDT in brackets.

• Cystic Fibrosis MDT – where we discuss the management of patients with cystic fibrosis and infective exacerbations of cystic fibrosis (specialist pharmacist and respiratory doctors)
• TB MDT – a double acronym for tuberculosis MDT where we discuss the management of all of our patients with tuberculosis (specialist nurses, specialist pharmacist, respiratory doctors)
• Endocarditis MDT – a ward round style MDT where we review every patient who has or may have infective endocarditis (specialist pharmacist and cardiology doctor)
• Neonatal and paediatric MDT – were we discussed the complex babies and children (specialist nurses, specialist pharmacist, doctors)
• Stop and read the map MDT – an ad hoc arrangement where a group of specialists from different disciplines come together at short notice to discuss complex patients and agree how to manage them, often on the intensive care unit (ICU) when the patients are really sick! The make up of the group depends on the specific details of the patient but usually involves an intensivist, a rheumatologist, a respiratory consultant as a minimum

 
The secrets to a good MDT
In my experience there are a few “secrets” to having a successful MDT:

• One person should be in charge – there should be one chairperson, one leader, one person who makes sure everyone sticks to the agenda and does what they’re there to do, it doesn’t matter what they’re job title is, just make sure they can keep everyone in line
• Have an agenda – make a list of what needs to be done, and stick to it, wait until the end for “any other business”, don’t get side-tracked
• Write it all down and discuss with the patient – this is not “The Council of Elrond” (sorry, Lord of the Rings joke about secret meetings), write down what the team decides in the patients notes and then discuss this with the patient. If the patient wants an alternative plan, then come back to the MDT and discuss this again (although the patient’s wishes should ideally have been known beforehand, although this isn’t always possible with new patients who haven’t been met yet)
• Block the time in your diary – have the MDT as a standing item at the same time and frequency and then do not let anyone for any reason put something in your diary that clashes. If people don’t turn up to MDTs then they waste a huge amount of time! On that note, if you can’t go then try and find someone to go in your place…
• Make them “fun” – try to enjoy MDTs, don’t see them as a chore or necessary evil. I once had a colleague who always made sure there were Jaffa Cakes available at every MDT she went to. One of the things I love about MDTs is that I get to know more about the people I work with, and that’s great. I know about pets, family, holidays, all sort of things (even Bedlington Terriers who like to steal computer cameras… you know who you are!) and my friends know about me as well, and that makes it fun!

 
There you go, not all acronyms are bad. Some like MDTs are really the heart of medicine and can be really fun.
 
So next time you have to “d/w Rx at the MDT to Dx a Pt Ix” think about it… yes, it is actually okay to “discuss with radiology at the multidisciplinary team meeting to work out how to diagnose a patients infection”.