Our multidisciplinary team: how we review complex cases

Governance

Not every case is straightforward. Some involve a medical history that changes the risk picture. Some involve previous surgery, here or elsewhere. Some involve a patient whose expectations and what surgery can realistically achieve are not yet in the same place.

When that happens, the decision does not sit with one person. It goes to our multidisciplinary team.

What an MDT is

A multidisciplinary team (MDT) brings together clinicians from different disciplines to review a case together. It is established practice in the NHS for complex conditions, and we apply the same principle here.

Depending on what the case needs, an MDT review may involve the treating surgeon, our Medical Director or a Medical Advisor, senior nursing input, anaesthetic input, and other clinical specialists relevant to that patient.

When a case goes to MDT

A case may be referred for MDT review when:

  • There is a significant medical history that affects surgical or anaesthetic risk
  • The patient has had previous surgery that complicates the planned procedure
  • Revision surgery is being considered
  • There is a question about whether the requested treatment is clinically appropriate
  • Assessment has flagged something that would benefit from more than one opinion
  • Any member of the clinical team asks for it

That last point matters. Escalating a case does not need to come from the top.

What happens in the review

The case is presented with the clinical notes, assessment findings and any imaging. The team discusses the risks, the alternatives, and whether the proposed plan is the right one.

A review can conclude in several ways. It may confirm the plan as proposed. It may modify it, for example by staging the surgery differently or changing the technique. It may recommend deferring treatment until something is addressed first, such as weight, smoking or blood pressure. Or it may conclude that the treatment is not clinically appropriate, in which case we say so and explain why.

Why we do it this way

Reviewing a complex case properly takes time, and it sometimes ends in a no. We think that is the correct trade.

A single clinician can miss something. A team is more likely to catch it. And a structure where declining is a normal, recorded, supported outcome is a structure where clinical judgement is protected from every other kind of pressure.

What this means if you are a patient

If your case is reviewed by the MDT, you will be told. You will be told the outcome, the reasoning behind it, and what your options are.

You will not be left to work out from a change of plan that something has been discussed about you.

Call to action

Every Transform patient is seen by a qualified clinician before any decision about treatment is made.

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