A multidisciplinary approach has been baked into the philosophy of Edward Dohring, MD, from the start of his career. At his practice, Scottsdale-based Spine Institute of Arizona, he emphasizes the importance of regular meetings across specialties and learning from each other.
Dr. Dohring shared his insights about this approach on the “Becker’s Spine and Orthopedics Podcast.”
Note: This is an edited excerpt.
Question: What are some of your top priorities in spine care right now?
Dr. Edward Dohring: My priorities have been the same the entire time we’ve had the Spine Institute of Arizona open for business, which is patient care and commensurate with that is really trying to be on top of those innovations that make sense for patients. We’ve been involved in a lot of FDA investigational device exemption trials trying to work on things that had to do with the first minimally invasive type approaches to different procedures, the first artificial discs and disc replacement procedures.
At the same time, we are a multidisciplinary group. When we started, that was very unique, and we try to work together by having meetings every week to share ideas, so we’re not ensconced in our silos. … Finally with education, we’ve been priva-demic in nature, where we educate nursing students, PA students, medical students, residents and fellows.
Q: Can you share more about the multidisciplinary work you’re doing and if you have any examples of lessons you’ve learned from a colleague in a different field?
ED: Everybody comes at their patient care perspective from a different background, and some of those backgrounds are ensconced in our training and some of them are just our own pathway in life. What’s been great about how we started the institute is that from the very beginning we included people who are in interventional pain, physical therapy, chiropractic and surgeons. Because we have weekly meetings and talk about patients, the literature in our own fields and what we learned from a conference, we’re constantly sharing ideas that we wouldn’t be otherwise exposed to.
For example, I might think a patient is a good surgical candidate, discuss them and realize my colleagues can approach them in a different way that’s better. That way we learn from each other all the time. It’s one of the things that led me to be very involved in the North American Spine Society, because it is one of the few multidisciplinary organizations focused on spine care of patients. Even though we are surgeon-heavy, over 30% of the membership is nonsurgical and represents all the other fields that take care of the spine, and they have a strong voice at every level from committees to conference education to the board.
Q: Where do you think the role of interventional spine physicians and pain management is growing? Are you optimistic or nervous?
ED: I think it’s an important topic. Before interventional pain fellowships existed, where people really learned how to do different kinds of injection approaches to patients’ problems, this was done very ad hoc. Occasionally an anesthesiologist would do it, occasionally radiologists do it or a surgeon would do it, so it definitely increased the quality of care tremendously.
It was really about 20 years ago or so that the interventional pain fellowship started becoming more widespread and people started coming out of this training with a focus on how they could help patients with these minimally invasive procedures that could really help patients. I think as we’ve gone along, it’s morphed into a situation where some of the interventional pain people are doing procedures that would be more ideally adopted by those who have more training and anatomy and diagnosis and in the potential complications of these procedures.
When I was president of NASS, with the concurrence of our pain management and interventional pain physicians issued a statement saying we felt it was most appropriate, especially when we’re talking about fusions, that patients be treated by those who are neurosurgically trained or orthopedically trained six to seven years on the anatomy and diagnosis of spinal conditions and then surgical procedures and complications. They’re probably not best in the hands of a person with a year of interventional pain training.
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