Haemostasis 10 (Suppl. 1): 49-50 (1981)
Questions and Answers - Workshop on Comprehensive Care
(Workshop I)
Question: How does one manage to keep an much less immediately available than nurses, and
orthopedic surgeon or physical therapist interested in patients often hesitate to ‘bother’ a doctor with a ques
the treatment of patients with haemophilia? In our own tion which they might regard as trivial. For these
experience such individuals often prefer other kinds of reasons, the nurse practitioner is often the first point of
activities and do not consider haemophilia an important contact on a day-to-day basis, and has the responsibility
task. of integrating the team members in a meaningful way
Answer: A s is true for most other spheres of life, and of triaging questions and health care problems to
there are multiple motives which will cause an indi various team members. The close working relationship
vidual to become interested in a given area of work. between the hematologist and the nurse helps to max
One must recognize these and make use of them. For imize the chances the patient will not be ‘lost within the
example, it is important to some individuals to become system" and yet will get immediate access to whichever
a local expert in a given area, and to develop a reputa team member seems most appropriate.
tion for excellence in this area. In a haemophilia center Question: Why is there a need for a psychiatrist as
it is relatively easy to promote this idea and to make part of a haemophilia team? Does this suggest that the
someone ‘the local expert’ on a particular aspect of haemophiliac accepts serious mental problems?
haemophilia for a large region or an entire country. Answer: In the experience of the American
Another motive might be the development of a team haemophilia centers, a psychiatrist very rarely sees the
relationship, which many people find very rewarding. A patient. Instead, the psychiatrist serves a liaison func
third aspect is the fact that in a chronic illness such as tion and helps various other team members to develop
haemophilia one can establish long-term relationships approaches to everyday real life problems of individuals
with a group of pleasant individuals and family mem with a chronic disorder. Serious psychiatric disease
bers. It becomes a great pleasure to see these relation turns out to be quite uncommon in the experience of
ships grow and develop over the years. Finally, the most hematologists, but the kind of psychiatric and
academic and research aspects of involvement with a psychologic problems with which a social worker must
haemophilia center may be used to help entice certain deal can make the difference between success and fai
people to develop an interest in becoming involved with lure. For example, the myriad of school problems,
the activities of a haemophilia center. interactional difficulties, adolescent behavioral prob
Question: Who is ultimately responsible for what lems, daredevil behavior, sexual maladjustments, etc.,
happens to the patient, when a haemophilia team is in which any group of chronically ill patients are prone to
place? Is there a danger of the patient not being sure of develop from time to time, do remarkably well with
who is in charge or with whom to communicate? simple reassurance and education delivered by the
Answer: Y es, there is definitely a danger the social worker.
patients will become ‘lost’ in a team, and one of the Question: How can we convince our local
roles of the nurse and haemophilia center coordinator, hematologists that centralization of care programs is
at least in the American haemophilia centers, is to more beneficial to haemophiliacs than decentralized or
assure that this does not happen. It must be clear to all independent care?
members of the team that the hematologist is the one Answer: This is a problem which plagues all the
ultimately responsible for all aspects of the patient’s developing areas of the world and which in fact is still a
care, and still he should be an individual who can problem in many of the most highly sophisticated medi
develop a close personal bond with the patient over a cal care systems of the world. In the last analysis, it
long period of time. On the other hand, physicians are seems that the best method is to demonstrate excel
Questions and Answers - Workshop on Comprehensive Care
(Workshop I)
Question: How does one manage to keep an much less immediately available than nurses, and
orthopedic surgeon or physical therapist interested in patients often hesitate to ‘bother’ a doctor with a ques
the treatment of patients with haemophilia? In our own tion which they might regard as trivial. For these
experience such individuals often prefer other kinds of reasons, the nurse practitioner is often the first point of
activities and do not consider haemophilia an important contact on a day-to-day basis, and has the responsibility
task. of integrating the team members in a meaningful way
Answer: A s is true for most other spheres of life, and of triaging questions and health care problems to
there are multiple motives which will cause an indi various team members. The close working relationship
vidual to become interested in a given area of work. between the hematologist and the nurse helps to max
One must recognize these and make use of them. For imize the chances the patient will not be ‘lost within the
example, it is important to some individuals to become system" and yet will get immediate access to whichever
a local expert in a given area, and to develop a reputa team member seems most appropriate.
tion for excellence in this area. In a haemophilia center Question: Why is there a need for a psychiatrist as
it is relatively easy to promote this idea and to make part of a haemophilia team? Does this suggest that the
someone ‘the local expert’ on a particular aspect of haemophiliac accepts serious mental problems?
haemophilia for a large region or an entire country. Answer: In the experience of the American
Another motive might be the development of a team haemophilia centers, a psychiatrist very rarely sees the
relationship, which many people find very rewarding. A patient. Instead, the psychiatrist serves a liaison func
third aspect is the fact that in a chronic illness such as tion and helps various other team members to develop
haemophilia one can establish long-term relationships approaches to everyday real life problems of individuals
with a group of pleasant individuals and family mem with a chronic disorder. Serious psychiatric disease
bers. It becomes a great pleasure to see these relation turns out to be quite uncommon in the experience of
ships grow and develop over the years. Finally, the most hematologists, but the kind of psychiatric and
academic and research aspects of involvement with a psychologic problems with which a social worker must
haemophilia center may be used to help entice certain deal can make the difference between success and fai
people to develop an interest in becoming involved with lure. For example, the myriad of school problems,
the activities of a haemophilia center. interactional difficulties, adolescent behavioral prob
Question: Who is ultimately responsible for what lems, daredevil behavior, sexual maladjustments, etc.,
happens to the patient, when a haemophilia team is in which any group of chronically ill patients are prone to
place? Is there a danger of the patient not being sure of develop from time to time, do remarkably well with
who is in charge or with whom to communicate? simple reassurance and education delivered by the
Answer: Y es, there is definitely a danger the social worker.
patients will become ‘lost’ in a team, and one of the Question: How can we convince our local
roles of the nurse and haemophilia center coordinator, hematologists that centralization of care programs is
at least in the American haemophilia centers, is to more beneficial to haemophiliacs than decentralized or
assure that this does not happen. It must be clear to all independent care?
members of the team that the hematologist is the one Answer: This is a problem which plagues all the
ultimately responsible for all aspects of the patient’s developing areas of the world and which in fact is still a
care, and still he should be an individual who can problem in many of the most highly sophisticated medi
develop a close personal bond with the patient over a cal care systems of the world. In the last analysis, it
long period of time. On the other hand, physicians are seems that the best method is to demonstrate excel
