Interprofessional Case Study: Johnny [CC]

Summary

In this family health team meeting, Johnny, a 15-year-old struggling with academics, weight issues, and diabetes, and his family meet with a multidisciplinary team to address his challenges. The team includes a nurse practitioner, physician, social worker, nurse, health educator, and dietician. Tensions arise due to poor communication, role conflicts, and missed opportunities to address Johnny's emotional and academic needs. Despite suggestions for lifestyle changes, family dynamics, and school involvement are overlooked, highlighting the need for better coordination and team collaboration to address Johnny’s holistic health needs.

Takeaways

• 😀 Johnny, a 15-year-old with diabetes, faces challenges in school, health, and emotional well-being, including low grades, weight gain, irritability, and lack of interest in activities.
• 😀 Johnny's family is concerned about his health, especially regarding his weight and lack of interest in school, but his father’s alcohol use adds complexity to the family dynamics.
• 😀 The Family Health Team at 'The Doctor Is In' includes diverse health professionals such as a nurse practitioner, social worker, dietitian, pharmacist, and health educator to address Johnny's needs.
• 😀 Team members often face communication breakdowns, with interruptions, role confusion, and uncomfortable seating arrangements impacting the effectiveness of the meeting.
• 😀 Dr. Goodman’s interruptions to teach medical students and quiz them on diabetes management hindered the flow of the discussion, distracting from Johnny's specific needs.
• 😀 The nurse practitioner, Steph, did not involve the dietitian (Jethro), despite Johnny’s dietary concerns being central to his health issues, showing a lack of coordination in team roles.
• 😀 Johnny struggles with body image, which contributes to his withdrawal from activities like swimming, and this emotional aspect is addressed by the social worker, Ian.
• 😀 There is a need for a holistic care plan that incorporates Johnny’s physical health, emotional well-being, and social circumstances, but this requires better teamwork and communication.
• 😀 Ian, the social worker, suggested reaching out to Johnny’s school for collaboration on his care, but Dr. Goodman declined this suggestion, citing concerns about patient confidentiality.
• 😀 The family meeting demonstrated the importance of an interprofessional approach, but a more structured and respectful communication process could have improved its effectiveness and inclusiveness.

Q & A

What is the primary concern with Johnny's academic performance?

Johnny is struggling academically with low grades, lack of engagement, and difficulty staying focused in class. He is often distracted, sits at the back of the classroom, and has difficulty staying awake during school hours.

What social and health issues are affecting Johnny's well-being?

Johnny is overweight, has poor eating habits (mainly snacks on junk food), and lacks physical activity since quitting the swim team. Additionally, he struggles with body image issues, particularly feeling ashamed of his weight.

Why is Johnny’s father’s behavior a concern during the meeting?

Johnny’s father is visibly under the influence of alcohol, as Mandy notices the smell of alcohol on his breath and observes his slurred speech. This raises concerns about his ability to contribute positively to Johnny’s care and possibly impacts the family dynamic.

How does the healthcare team address Johnny's diabetes management?

The healthcare team discusses Johnny’s insulin regimen, but the focus shifts to medical education, and not all team members are effectively involved. Dr. Goodman frequently interrupts to teach his learners, leading to disruptions in patient-centered care.

What role does the dietitian play in Johnny’s care, and why is their involvement questioned?

The dietitian, Jethro, is initially absent from the meeting, which is a significant oversight considering Johnny's poor diet and weight concerns. Nurse Practitioner Steph dismisses the need for the dietitian, despite the clear importance of nutritional guidance in managing Johnny’s health.

How does the healthcare team handle communication with Johnny’s family?

The team includes Johnny’s mother in the discussion, but they fail to engage both parents in a meaningful way. Johnny’s father is distant and uncooperative, and there is minimal follow-up on his potential alcohol issues. The team could benefit from more inclusive family engagement.

What are some signs of poor communication within the healthcare team during the meeting?

Poor communication is evident in the interruptions by Dr. Goodman during discussions about Johnny’s care. Additionally, the team struggles with seating arrangements, making the physical space uncomfortable. The lack of clarity regarding roles, such as the dietitian’s absence, further highlights communication issues.

What role does the social worker, Ian, play in this meeting, and how is his role treated?

Ian, the social worker, is added to the meeting last minute, which frustrates him. His expertise in family dynamics and social issues is underutilized. His concerns about being treated as a secondary professional reflect a lack of integration within the interdisciplinary team.

How do team members address Johnny’s psychological and emotional well-being?

Johnny expresses feeling ashamed of his body, which is tied to his weight gain and quitting the swim team. The team suggests lifestyle education and potentially involving the physiotherapist, but the emotional and psychological aspects of Johnny's self-esteem are not fully addressed in depth during the meeting.

What can the healthcare team do differently to improve Johnny's care?

The team should work on better communication and coordination, ensuring all team members, including the dietitian, are involved. They need to focus more on Johnny’s emotional well-being, engage both parents effectively, and create a more respectful, inclusive environment that encourages family participation and professional collaboration.