How to be useful in MDT's

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How to be useful in MDT's

Postby sv650biker » Thu Jun 08, 2017 8:04 am

Hi all

The subject title says it all; how can we be useful in MDT's?

I am the only psychologist in my team and by default, attend all the team MDT's. I do not know if this is isolated to my team but there seems to be very little thinking and reflective space. The motto is "lets go through this as fast as we can" and every individual is only given 5 - 10 minutes to talk about a case (we are literally timed on this).

This makes it very difficult to offer useful contributions, do a bit of brief formulation work or even encourage discussion. The eyes start rolling and comments are made ("we're spending too much time on this", "discuss this outside the MDT") when 10 minutes are breached which is not great.

What are people's experiences of being a psychologist in an MDT? How do you view your role in an MDT and offer contributions? i.e. are there key questions you tend to ask or do you reflect from a particular theoretical model?

Thanks!
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Re: How to be useful in MDT's

Postby workingmama » Thu Jun 08, 2017 8:44 am

I guess my own current MDT experience is very different to this. I'm the sole psychologist in my MDT (although there are two others in separate, but quite closely linked areas), and my team is very psychologically willing, so it very much feels like pushing on an open door (most of the time). Where there has been a clear need to discuss cases longer than we would have time for, on the whole people have been willing to agree to arrive 15 minutes early for the next MDT so that I can spend a bit of time outlining what I think we need to hold in mind with different clients. In the cases where there has been enormous resistance to thinking psychologically about a client, I've talked to people in the MDT individually on a very informal basis t give them some background, so that when that client is raised at MDT again, there is a network of 'people in the know' to support my views or arguments. I've used a short written summary of client's situation and needs to hand out in cases where it has been clear that this is the only way of potentially getting the information across. Sometimes I have to use my 'I am the master of the universe and what I say is the literal word of truth' voice, and that seems to work a bit too. :lol:

I have worked in an MDT where it was made very clear that psychology was 'common sense and tree hugging', and in that case I left when I could and worked elsewhere (sorry - I'm sure other people will have great ideas about how to win hearts and minds, but it was crushing me!)
Fail, fail again, fail better.
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Re: How to be useful in MDT's

Postby alexh » Fri Jun 09, 2017 12:05 pm

I loathe a bad meeting. The wasted staff time, financial cost and especially the lost opportunity to use the assembled knowledge and expertise well to improve the service provided to people.

I therefore connected most to your comments about the MDT meetings, rather than the more general question of how psychologists contribute to MDTs. I would hope that by tackling that smaller task the larger question of psychological input might also be addressed, and that doing so would increase credibility to make more input elsewhere.

It sounds like rather than lacking structure, a very rigid structure has been adopted. Could you first try to understand how this came to be, the historical context and evolution of the process. Was it introduced to solve a different problem? Have the team experienced critical or serious incidents, entries and exits of staff, wider organisational changes? Are caseloads overwhelming and therefore quantity is prioritised over quality?

Whilst collecting that information you could watch for the opinions within the team. Who feels the meeting is working well and who would prefer a different approach? Whose voices are heard? Who are your allies (particularly as a lone psychologist) and who is happy with the status quo, and why? Who might undermine or be a barrier to change? Often I have sensed general unhappiness with a meeting but no-one has felt empowered to suggest changes or known how to do it differently.

I'd definitely want to keep track of the case discussions, and analyse that data. It may already exist, in the form of minutes, case discussion summaries or action logs, which could be brought together. For example, do the same cases return each week for another 10 minutes, or do the same people bring cases whilst others don't? I would be surprised if neither of these were the case.
What influences bringing a case and whether it is discussed, risk, complexity, lack of change or deterioration? Are cases prioritised at the outset, and on what criteria? Is a specific question being brought, and are specific actions allocated to responsible parties at the end of the discussion? Is there any review of the outcomes of the actions, particularly when a case returns again and again. Are the cases not discussed then brought forward to the following week, or are there some 'rumblers', which never get discussed but seem to need input.

Data allows you to demonstrate any problems with the current structure. You could also survey attendees in general and those who bring cases on their satisfaction and the effectiveness of the discussions.

Generate alternatives, from the evidence base on effective MDT meetings, or brainstorming within the team (assuming you have now got them on board - what 'stage of change' are they at?).

If they are ready for change, pilot one of the ideas and evaluate the outcome.

If they are not ready to contemplate change, you might consider establishing alternative forums like formulation sessions, 1:1 or group sessions, or group reflection or supervision. Of course, these can also be difficult to establish when staff are under pressure, as they must give up time to attend, whereas they may be required to attend the MDT meeting.

I also wonder what would happen if you simply stop attending. I'm not sure I'd be brave enough to do this but I might consider sharing the question with colleagues, do I need to be here if I can't contribute much due to the format?
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