# Building successful relationships within the patient's medical neighbourhood

Canonical source: [https://www.braver.net/en/blog/medical-neighbourhood-interdisciplinarity/](<https://www.braver.net/en/blog/medical-neighbourhood-interdisciplinarity/>)

The Braver journal

I like the saying, "It takes a village to raise a child." I like it because it embodies the power of a community and the many dimensions of a human being.

![Marie-Lou Gagnon](<https://www.braver.net/blog-assets/39b0cb41df4807f1f2af-960.webp>)

 Marie-Lou Gagnon September 1, 2021

![Building successful relationships within the patient's medical neighbourhood](<https://www.braver.net/blog-assets/legacy-c76f8bf4f99593f38d02-960.webp>)

The adult we become has been shaped by the community we grew up in, but even more so by all the special connections we developed with the people around us:

- *our Grade 4 teacher, who taught us the importance of not interrupting*
- *our soccer coach, who taught us perseverance*
- *our grandmother, who showed us unconditional love*
- *our best friend, who showed us what listening means.*

This transition from childhood to adulthood is a period of intense, formative growth that sometimes leads us to believe that our adult selves are rather fixed. As though we no longer evolve, and the people around us no longer matter as much to our identity. In my view, that is mistaken. We could therefore adapt the saying above to adults, and it would read: "It takes a whole community to support an adult."

I believe this, and I am not alone, because the College of Family Physicians of Canada has been working for several years on the concept of the "Patient's Medical Neighbourhood" ([source](<https://patientsmedicalhome.ca/fr/vmp-trousses-doutils/>)):

> *"The concept of the patient's medical neighbourhood takes the idea of team-based care in family medicine centres further: it describes and reinforces the idea of a network made up of multiple care and service providers outside the clinic."*

It is a theoretical concept that proposes concrete actions to establish this approach to care. One of the actions proposed in the guide concerns interprofessional collaboration: *"Establish interprofessional relationships to ensure greater continuity of care."* In other words, family physicians are encouraged to build relationships of trust with the other care providers surrounding their patient, known as the patient's neighbourhood.

This collaborative approach is disarmingly simple when you think about it, yet endlessly complex. So I would like to share the implementation steps recommended by this guide to support the development of successful interprofessional relationships.

## **1. Ask the clinicians to whom you refer your patients how they see your relationship**

But why is it recommended that we formalize our relationships with our collaborators? To answer that question, I will turn it around: is it possible to build a relationship of trust without agreeing on the nature of the relationship?

I believe it is, but it will take longer.

For example, building a sincere, lasting friendship can take time as an adult. But perhaps the friendship would develop more quickly if, along the way, we asked the other person: "*Would you like to be my friend?*" The example is amusing, but I believe human beings feel more trusting in a context of transparency and honesty.

## **2. Create a collaboration agreement suited to the clinician's practice, the collaborator and the patient**

This collaboration agreement identifies the elements each person wants to see in referrals, the preferred communication platform, expectations for communication in emergencies, expectations around timelines for taking on care and sharing results, and each person's roles and responsibilities.

These elements are highly relevant and even more important to establish where clinicians are highly interdependent, such as a family physician who collaborates daily with a nurse practitioner or pharmacist in a family medicine group (GMF).

However, how far should this agreement go when it involves healthcare professionals working in two different clinics, where the degree of interdependence is much lower? For example, a psychologist and a family physician who collaborate less frequently.

My first reaction on reading this was to think that making a collaboration agreement with other clinicians was a bit excessive. But I quickly caught myself, remembering that interprofessional collaboration is hardly something we have mastered in practice.

Then I remembered what some healthcare professionals told me during my research on collaboration: clearly understanding each person's roles, responsibilities and expectations is a condition for successful collaboration. So, where possible, we should establish a basic agreement with our collaborators to set the ground rules and give collaboration the best chance of working well. Perhaps this agreement could be made right at the beginning of a new collaboration?

## **3. Where no collaboration agreement is developed, focus on building and maintaining the relationship**

The healthcare network is not hospitals, CLSCs, private clinics and community organizations; it is people working to care for and support other people.

What I mean is that behind every act of care, intervention or care arrangement, there is a person. And our healthcare network will never be stronger than the ties between its healthcare professionals.

Building this relationship in an interdisciplinary setting means:

- Caring about the clinicians who cross paths with the patient in your office, because they have a meaningful role in that patient's continuum of care.
- Cultivating trust with your collaborators, because without them, your treatment plan may not be as effective.
- Being as empathetic toward your collaborators as you are toward your patient, because tomorrow they may be the ones lending you a hand.

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Being a healthcare professional is not always easy. Sometimes we put the weight of the whole world on our shoulders to help our patient. We want to solve everything. Or, conversely, in some cases we wonder whether we really are the right person to help.

That is why the patient's neighbourhood is essential. Because it is not only what is best for the patient, but also for the professional who sometimes struggles to keep their head above water.