Category Archives: English

Should medical institutions be led by physicians?

At the beginning of my training, I used to believe that medical organizations should be led by physicians, but is this the right thing? I still believe this; however, I understand now that the physician led organization model might not be right all the times or in all places. Actually, only a few hospitals have physicians as leaders and have managers instead.

The lack of interest of many physicians to become involved in administration, the deficit in administrative and financial knowledge of many, along with the need to obtain short term financial results better served by an administrative leader,  left many health care organizations to be led by administrators. Not to mention something that we all have heard at least once:  “I’m here for the important things; I must go to the OR”.

Image courtesy of sheelamohan at FreeDigitalPhotos.net
Image courtesy of sheelamohan at FreeDigitalPhotos.net
Big changes are succeeding in health care. The value concept in terms of outcomes and costs, the migration to a payment model that rewards for better results and the integration of patient care, shifted the model from a volume-based one to a value-based one. These are all topics where physicians can generate a positive impact. However, not every physician is prepared or is willing to get involved in administration. For sure, some leadership and management training is necessary. Understanding financial data, interacting with information technology teams, being able to communicate with others among different levels in the organization and  listening to their needs, were the most useful things in my personal experience. Having peer recognition is also a valuable thing to have: when you have it, things just flow easier. It’s important for a physician that is just starting to have some leadership role, to perceive that his ideas and actions are taken into account and help to make the organization a better one, facilitating the engaging process.

Nobody expects a doctor to decide alone about an investment, be a tax expert or lead an IPO for a big health care company. However, health care is a service and services depends on processes and on the individuals that offer the service. The better the process and the people, the better the health care experience. And here is where huge opportunities for improvement appear. Physicians are the core of the health care service and nobody is in a better position than a physician that has walked into every hospital room, to understand the patients needs and address their concerns.

Although there is evidence that many of the best performing hospital are led mainly by physicians, I have to accept that not every organization will be better off led by doctors. Not every country is going through the changes I mentioned before. Value is a key concept, but as long as reimbursement is not tied to outcomes, only few hospitals will have the incentive to provide better patient care. In my country, results are not tied to reimbursement. As a thoracic surgeon I have a team that provides the best possible care to every one of our patients, but I admit this might not be the case everywhere in my country. And when volume is more important than quality, hospitals might be better served by managers, but not by physicians leaders.

In health care, opportunities for improvement are everywhere. We should embrace these and work along with administrators as a team to provide efficient and valuable care and redesign for the best the health care experience for our patients.

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Small Central Ground Glass Opacity: how do you proceed?

What do you do with a case like this? It’s a 65 year, smoking history of 20 cigarettes a day for 30 years, that got a CT scan for other reason and a GGO spot was found in the left upper lobe. The nodule was sized in 1 cm and the doctor that saw the patient ordered a PET-CT that showed SUV of 5. Nothing lighted up in the mediastinum or elsewhere. Bronchoscopy was normal. FEV1 is 1.35 liters (50%) and DLCO 65%. He hasn’t any other significant health issue. The patient is not very anxious about this finding and he wants to know your suggestion. What are the options?

I guess you might try to stick a needle on it, but your radiologist should be very skilful to target this tiny spot in the middle of the lung, especially in a patient with emphysema. The risk of pneumothorax is significant.

What other options? Well, I don’t have any experience with navigational bronchoscopy, but if any has, it’ll be great to hear any input. The two other options I can think of are surgery or just wait. I’m not very keen on waiting in a case like this, but I accept somebody may have this as a suggestion. Surgery will take a lobectomy, as the spot is in the middle of the upper lobe and very close to a PA branch.

What do you think is the best option? Do you think you can take it out with a lesser resection than lobectomy?

 

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