|Requisite Mona Lisa |
sighting at the Louvre
|Bridge over the Seine river with the Louvre backdrop|
|A beautiful sight anywhere in the city|
This last week went by faster than I thought partly because I knew it was the last week and because I was busy both inside and outside of the hospital. Dr. Basto kindly invited me to his house for dinner. I had a wonderful time meeting his wife and children. His wife cooked an amazing dinner along with several desserts!
Observations from this final week:
|Serghei, a medicine intern, and his wife, Olga, hosting me for dinner|
|Serghei and I on the famous Dom Luiz bridge overlooking Porto below|
|Dr. Basto and his family hosting me for dinner|
|Port wine, nata, and other desserts |
made by Mrs. Basto!
-I had the chance to see the stroke unit this week as a friend and colleague of Dr. Basto's helps run it. We got to talking about the "fast-track" system set up at Sao Joao along with other hospitals in the area. Basically, once a stroke comes it, the team is immediately called allowing them to see the patient, review imaging, and come up with a diagnostic plan within the allotted time for thrombolytic administration if needed. The stroke unit at Sao Joao consists of internists and a neurologist. Given the structure of the "fast-track" system, it is clear how it can be replicated at other hospitals and objectively assessed for compliance. This brings up the issue of regulation vs autonomy. As physicians, we train in order to have the knowledge to assess each situation and make a thoughtful decision. However, a "fast-track" system is, in essence, evidence-based regulation regarding stroke management. Physicians do have some autonomy, but it is within the framework and guidelines written. If I had to choose, I would argue for more structure with some sacrifice on autonomy if this can yield better patient care in the long-run. Per Atul Gawande, a checklist might force a surgeon to review items he believes he covered, but it allows for a systematic approach reducing medical error. I think the worry is that physicians will no longer have the freedom to think through patient management and instead simply be following one guideline after another. However, I think there will always be further research and innovation on these guidelines and patients will still need personalized care. The area where a "fast-track" system for stroke or other overarching guidelines can help is in rural parts of a country that might not have as many physicians nor the resources in place. These guidelines allow for systematic improvement in whatever the disease focus.
|Porto at night|