Emotional group think and multi-disciplinary teams

In theory multi-disciplinary teams (MDTs) provide best practice care for patients with cancer. This is potentially true but it should also be remembered that care designed by a committee may turn out like anything else designed by a committee ….. not so good.

Individuals making decisions are subject to biases but so are groups of individuals. Over time teams can come to adopt the same pattern of thinking – group think. In addition teams, just like individuals, are subject to emotional decision making.

I’ve come across a couple of decisions this week that we discussed in our liver cancer morbidity and mortality meeting. Both cases were complex and it is fair to say both cases had advanced cancer with a high risk for decompensation or deterioration of the underlying liver disease. In both cases I think the team decided to offer treatment, arguably, despite their best rational and evidence based judgement, because they wanted to do something for the patients. I was a guilty participant in the folly of rationalising why treatment could be offered whereas ordinarily we would have said enough is enough. In both cases complications ensued (I should note they might have eventuated without our treatments just due to disease progression). In both cases I think the individuals understood the risks being undertaken.

MDT are opportunities for healthy debate and pursuit of best practice. In some cases the evidence is deficient and we learn by experience. The experience this week is that when we let our emotions take over we must re-calibrate and come back to the evidence. The other lesson is we must be able to explain this to the patients.

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