The issues identified here were identified in a process and task analysis of the work of a multidisciplinary medical team (MDT) and their meetings (MDTM). Structures are evolving and issues are emerging with respect to work processes. Problems are identified that are associated with the handling of ‘consultations’ and ‘referrals’ to members of the MDT and are summarised in Table I. There are lesser associated issues when ‘referring back’.

An individual patient is assigned under the care of a single doctor and that doctor may consult with others or pass the care to another doctor (specialist). The consultation or trans- fer is usually initiated by letter (or phone call) between the referring doctor and the specialist they expect will be better able to look after that patient. Traditionally the specialist will ar- range to see the patient for assessment and will then make a decision on management.

Structures are changing and the development of MDTs has had an impact on how pa- tients are being managed. Services are being delivered through specialist centres, dispersed geographically and linked via teleconferencing technology. In tandem with service restruc- turing, the level of MDT working in increasing with a resultant increase in the number of patients being managed through MDTMs. There is more shared, or collective, responsibility among MDT members (even though patients are technically assigned to one doctor).

Some problem areas have been identified in the handover of patients within a single multidisciplinary team, between different teams and between different hospitals that need to be resolved for the system to be efficient. The question “So, who is looking after this patient?” may not be so easily answered and may become even more difficult to answer in the future if systems are not in place to explicitly designate tasks and responsibilities.