MDTs: where science and medicine meet

Over the last few months, I’ve visited some of our funded researchers and been lucky enough to see first-hand how their clinical multidisciplinary teams (MDT) and laboratory staff meet together regularly to discuss how to ensure their patients get the best care possible.

We’ve often talked about the importance of bridging the gap between the hospital and the lab, and nowhere is this more apparent than when a clinical MDT works in close harmony with their laboratory-based colleagues.

Let’s talk about the MDT first. This can be between 16 and 20 people and include everyone involved in a prostate cancer patients’ care, from oncologists and radiologists to research nurses and laboratory scientists.

They generally start their meetings by talking about the in-patients and those on follow-up care one by one. I have been totally blown away by the level of detail they go into for each patient, and how well the clinicians remembered all the relevant information. They recalled everything, from what stage each man’s cancer was at when he started treatment, to how his treatment was going and whether anything unexpected had happened.

These meetings have been a real-life demonstration of the teamwork that goes into good healthcare. Everyone could chip in and contribute thoughts and ideas and they would be listened to. I was especially impressed by the prominence that patients’ own opinions and preferences were given in every conversation, down to taking account of holiday plans and how to make sure they feel well enough to enjoy their time away.

These are the sorts of discussions that MDTs across the UK might have about their patients. But the teams engaged in active research are a bit special, and what they do next is where the line between science and medicine starts to blur. Having discussed the routine treatment-related issues for each patient, they then note if there could be anything unusual in each man’s cancer DNA that might affect how well it responds to certain treatments.

Particular changes, or mutations, in the DNA might even suggest new treatments that could work better. Some clinical teams that are right at the forefront of medical research and innovation can use this information from the man’s cancer DNA to help them work out how best to treat him or whether there are any clinical trials he’d be suitable for.

Of course, for some patients, the sad reality is that there isn’t anything more the team can do. I could hear genuine sorrow and disappointment in their voices when they said this; these guys really care about their patients. And they never reached that decision before considering any and all possible alternatives. Only once the last medical options have been discussed do they talk about the other aspects of end-of-life care, like how he was feeling and whether he had appropriate hospice care lined up.

Next, the teams I visited talked about the patients currently on clinical trials. They went through trial by trial, patient by patient.

The overlap between science and medicine stood out again when it came to patients who didn’t respond quite as expected. The teams discussed results from other labs, working on other types of cancer, to work out whether their observations could give them any clues as to what was going on.

Once they’d discussed all their patients, there was a brief change-over period where some of the medics left and some other scientists joined the meeting.

Then it was over to the scientists to present some of their recent results, and open them out for discussion. These conversations covered everything from how the research was going to the most important question for this group: how does what they’re seeing in the lab relate to what they’re seeing in the clinic?

Once again, everyone in the teams chipped in with questions, comments and suggestions: things they’ve read that might be relevant, what they’ve heard about other groups doing, and what key experiments might complete the story.

And all research is just another kind of story. It always starts with a problem that raises some classic whodunit questions: What? When? Why? How? First the scientist investigates to understand the problem and start to work out the answers. Once they’ve got a theory, they need to examine and test it from different angles, before drawing a conclusion to round out the tale.

The beauty of the way that these combined medical and scientific teams work is that the scientists get to take their stories further than many pure scientists have the opportunity to do. I suppose, to continue the murder mystery analogy, their story doesn’t have to end with an arrest. They can continue it through to trial.

The majority of the research projects in labs like these link directly into one of the medical teams’ clinical trials. This is where they get to grips with exactly how and why a new drug works before it goes into a patient. Or, if something unexpected happens once it’s at trial, they take it back to the lab to find out what’s actually going on.

The real beauty of this sort of set up isn’t that the story of every drug or every patient has a single author, who writes the beginning, middle and end, but that it’s a true collaboration. Everyone brings something different to the table and, most importantly, everyone cares about what they’re doing and why. It’s inspiring to be a part of, even if just during a few brief visits.