Establishing Clinical Collaboration

By Olugbenga T. Okusanya, MD 

January 4, 2021

Surgeons have a distinct pleasure and challenge of interacting with many other physicians and subspecialists. This unique situation creates an opportunity for collaboration. Though we often speak about the benefit of collaborative research, we do not often talk about developing clinical collaboration. Clinical partnerships allow specialists from different disciplines to work together and tackle a particular disease. Clinical collaboration allows physicians to offer the broadest range of options for care, a well-balanced set of opinions, and considerations for a large number of nuances. Despite the potential benefits, clinical collaboration can be difficult to establish for several reasons. Collaborators may not be enthusiastic about working together due to financial remuneration, clinical volume loss, decreased autonomy, and unfamiliarity. Given these challenges, how does one go about building clinical collaboration?

"Clinical collaboration allows physicians to offer the broadest range of options for care, a well-balanced set of opinions, and considerations for a large number of nuances."

Assess the Clinical Landscape
When seeking clinical collaboration, the most crucial step is to determine the current landscape at your institution. Many diseases, such as achalasia, have multiple specialists who are involved in the care of these patients. Surgical specialists, such as minimally invasive surgeons and thoracic surgeons, as well as medical subspecialists like gastroenterologitsts, may be involved. Likewise, Type B dissections may be treated by cardiac surgeons, vascular surgeons, interventional cardiologists, and/or interventional radiologists. Thus, first we must identify who the key collaborators may be for a particular disease process. Often, simply start by asking the operating room staff, business staff, or even the surgical trainees at your institution who most often treats the disease in question. Once established, the next step is to reach out. 

Demonstrate Value
After you’ve made contact it is important to share what you bring to the table. The first is that as a specialist of different training, you can add rather than subtract value from your collaborator's clinical practice by offering new skills and perspective regarding the management of a particular disease process. Think of the situation or conditions in which your skillset may be advantageous. Perhaps you have expertise in transthoracic approaches to benign foregut disease that may avoid hostile abdomens. Maybe there are anatomic considerations that would favor a surgical approach or more specifically a cardiothoracic surgical approach. You also may be able to add value based on your location. Health care institutions are complex organizations that increasingly cover large geographic areas. You may be better suited to see patients at more remote parts of the system and develop a practice there that can be shared with collaborators. 

Set Up Clinical Conferences
Any physician will have particularly difficult and challenging clinical situations. A great way to manage these situations is to set up a recurring clinical conference where challenging cases can be discussed. This serves as an opportunity to provide unique insights from your perspective and training background in order to overcome challenging clinical scenarios. One example is an aortic valve conference where patients who are edge cases for transcather valves versus surgical valve replacement can be discussed. These conferences also have the benefit of being quite educational for trainees and also serve as fertile ground for research collaboration, which will support the clinical collaboration you are seeking to establish. 

"The development of these clinical collaborations requires patience, teamwork, and commitment, but the benefits can serve our patients and us well." 

Adopt a ‘Rising Tide Raises All Boats’ Approach
Clinical excellence in the care of patients will invariably result in more volume for everyone. Having a high-functioning, collaborative team will give patients the best care, and the best care will result in more referrals. A group being able to develop an expertise in dealing with difficult cases, recurrent disease, or reoperative fields will invariably see more of those cases and other aspects of the disease. Modern medicine is built on the strength of collaboration and collaboration is strength. 

Overall, the development of these clinical collaborations requires patience, teamwork, and commitment, but the benefits can serve our patients and us well. 

The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.

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