I very well remember my first experiences as a medical student in the operating room. I was ordered to stand in a corner with my back to the wall (just as the surgeon ordered), almost motionless because of the staff’s worry that I might touch and contaminate something sterile. I could only listen to the surgeon describing what he was doing. That was a humiliating experience and I was close to abandoning my goal of becoming a surgeon.
Quality of medical and surgical care is a profoundly felt need of every patient, of every involved family. Although based on slightly different motivations, the same is requested by those who pay for the care. Therefore, the interest in defining and measuring the quality of provided care is high. This is, however, a highly complex endeavor. It requires in-depth knowledge, differentiation, multiple perspectives and expert judgment.
How can we define “quality of care”?
The Institute of Medicine (IOM) of the US National Academy of Sciences defines it as “the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
Traditionally, technical skills in surgery are taught by the “apprentice model”: trainee surgeons learn under supervision in the operating room, by performing portions of or complete real operations on real patients.
This is one of the biggest emergencies in heart surgery, or, dare I say, of medicine in general. From a subjective wellbeing, a sudden sharp and excruciating pain in the chest makes the person reach out for medical help. As soon as the patient arrives to the ER, a diagnostic protocol for acute chest pain is carried out. Once acute myocardial infarction is ruled out, the patient must undergo a CT scan to either exclude or confirm acute aortic dissection.
On June 10th 2017, the formal graduation ceremony held at the TMEC Walter amphitheater at Harvard Medical School and the Certficate of Completion marked the end of a highly demanding yet interesting one-year training named GCSRT (Global Clinical Scholar Research Training). The study of key subjects in clinical research (biostatistics, epidemiology, ethics) was much deeper and thorough than expected. Side subjects such as self- and team management, as well as mentorship and leadership, were also integral part of the course.
Cardiac surgery underwent a huge change since its beginnings. From an adventurous, dangerous but lifesaving endeavour carried out by real Mavericks to a surgery, which is perceived almost as routine and expected to be safe, with good and predictable results. While this latter is true (in the vast majority of cases), the change doesn’t end here: meanwhile, cardiac surgery is perceived as almost too invasive, mainly due to its standard surgical access, the median sternotomy (i.e. the longitudinal split of the long breast bone). The major invasiveness of the access to the heart is against the contemporary trend of minimal access to the internal organs, if possible through a catheter inserted in a peripheral vessel.
In this new role all individual professional qualities, such as technical skills, clinical judgment and decision-making, are considered as granted. The new challenge is leadership.
It is a great pleasure for me to introduce to you a guest author on this blog, the psychologist and psychotherapist Martino Regazzi. Martino joined and reinforced the team of Cardiocentro Ticino about a year ago. He gives all of us (patients, nurses, cardiologists and cardiac surgeons) some precious help and structured insights on something right opposite of the spectrum of the highly specialized, cutting edge treatment we practice: the mind and soul. Although heart and soul are almost felt as a whole, we in the green and blue scrubs mostly take care of its somatic dimension. Of course, empathy and reassurance of both patient and family is an integral part of our attitude: however, it is not sufficient and sometimes we painfully feel it. The “other” dimension is not easy to handle as it is far more complex than we think! Therefore I am especially happy that Martino accepted my invitation to write the following post. A heartfelt thank you Martino!
(The artwork named “From the bottom of my heart” is exposed with permission of its creator David Munroe).
Robotic surgery has been hitting the headlines for years. Notwithstanding, it is not widely understood what robotic surgery is really about and what are the benefits and pitfalls of this technology.
Nowadays, when we talk about robotic surgery we mean surgery performed with the da Vinci telemanipulator (Intuitive Surgical, Sunnyvale, CA, USA). It is not the sole robotic system available, but it is indeed the most advanced authority cleared surgical robot. It is successfully commercialized worldwide and dominates almost 100% of the market.