Time to review utility of multidisciplinary team meetings

Eigenmann is right to question the efficacy of multidisciplinary teams (MDTs),1 which have become the accepted mode of working despite the flimsy evidence base.2

The consensus that MDTs are a good thing is rooted in several presumed benefits, such as standardisation and continuity of care, effective use of resources, improved trial recruitment, and safeguarding of patients (from maverick doctors).

Few of these benefits have been proved. The evidence in favour of MDT working is largely observational,3 or inferred.4

Several unresolved concerns go against the perceived benefits:

• MDTs are large: one study reported an average of 14 attendees. Case discussions lasted four minutes on average,5 which is unlikely to deliver the level of cross functional consideration that patients may assume their case will receive

• The MDT decides the patient treatment plan without the patient being present, which defies the principle of “no decision about me without me” and risks breaching the GMC good practice requirements to share information and discuss treatment options with patients before making treatment recommendations.

The suggestion that a patient advocate be present at the meeting is unlikely to be an adequate substitute for meeting the above principle. The proposal that patients be present at the meeting during discussion of their case is impractical.

A solution might be for doctors to discuss this with their patients before the meeting. Once referred, the patient’s primary relationship is with the consultant, so it would be appropriate for the consultant to discuss the treatment judgment he or she has made to assess the patient’s preferences before the MDT meeting.

The current MDT approach is labour intensive, threatens patient autonomy and confidentiality, and lacks substantive evidence of benefit. It is time to reconsider MDT working so that the problems can be resolved or alternatives considered.