This week

So this week, I've been spending some time at the Sree Chitra Tirunal Institute for Medical Sciences and Technology. It is a hospital that deals solely with cardiac and neurosurgical patients here in Trivandrum. I have been following one of the senior anesthetists around and observing some pediatric cardiac surgery. It is interesting to see that, in many ways the technology and training of the practitioners is essentially the same as the US. For example, the monitors and anesthesia machine used here are the same as in Boston or other major US medical centers. I think the major difference, is that there is no systematic approach to quality improvement or safety. There seem to be very few if any systems in place to prevent injury to the staff or the patient. There was discussion about a few strokes that have occurred over the past several months. When I asked what the etiology of the strokes was, I was told they just sometimes happen. There was no review of those cases to find any common threads that could be identified to prevent further events. That sort of approach wasn't even on the radar. So, I think that improvements here ultimately will have little to do with training or technology. Rather, there needs to be a sea change in the approach to evaluating care. There needs to be less of a blame culture and more open, self reflection. I think that this can only come about through the development of systematic approaches to evaluation, such as morbidity and mortality registers, complication databases, and the like.

Tomorrow, I'll be spending time with a remarkable organization. There is an anesthesiologist here who has pioneered a community based palliative care program that operates along community health models to reach poor people who would otherwise be unable to receive such care for end of life issues. More on that to follow. BTW -- I've almost reached my limit on dosa for a while.