What is an MDT and why do we need them?

What is a multidisciplinary team (MDT) and why do we use them?

Professor Ashkan explains all about MDTs and why they are so important to the medical world.

-   We are increasingly living in a world where not everyone can know everything. The body of knowledge and information available is growing. Therefore, no single person can know everything about everything! Because of that in the world of surgery, particularly something as complex as neurosurgery, we are becoming more and more subspecialised. This means that we are master of a specific area but not necessarily of the totality of any branch of medicine.

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-   As a result of this we need to work with our other colleagues who are the masters of their fields. This enables us to address all the needs of patients. For example, one of the fields I work in is neuro-oncology. The patients I see need a combination of treatments – it may be surgery, it may be radiotherapy, it may be chemotherapy or palliative care. These patients also have a wide range of investigations. These may be radiological, surgical or pathological to name but a few. As you can see I have already mentioned a number of specialist fields that these patients will need. So, to start we will need a surgeon, an oncologist, neuro-oncologist, radiologist, radiation-oncologist, pathologist, palliative care specialist, neurologist and that’s just the start. Almost all of these patients will need rehabilitation care as well so we would also need a physiotherapist, rehabilitation specialist, I could go on. What you can see though is the vast amount of knowledge needed to treat and look after these patients. Obviously, no one person can be the expert in all of these areas and it cannot be handled by just one person. Therefore, we bring together groups of these people who are the experts in their field meaning that the patient gets the holistic, complete, best quality care package for their treatment. These are called multidisciplinary teams (MDTs).

-   Another good example of the use of an MDT would be a spine MDT. Both complex and simple spine patients have a large number of considerations when it comes to how to best look after them and treat their symptoms. For some surgery might be the best solution whilst others non-operative management might be the most successful treatment pathway for them. Within a spine MDT we would normally see physiotherapists and pain specialist, spine surgeons, neurologists and radiologists to name just a few. Patients are discussed within the group to look at the best options for the patient – is it non-operative pain management, is surgery going to give them the best outcome, how is the rehabilitation going to be delivered? All these questions are answered with the patient’s needs at the forefront of discussion. A comprehensive spine MDT will have access to a psychologist because pain (like back pain and neck pain) will have consequences on the psychological wellbeing of the patient. Sometimes the pain can be made worse or the recovery reduced if the psychology of a patient is not optimized. So, this group meets to ensure every patient is offered the highest quality, holistic treatment pathway.