Search Distinctions

 

• Current Distinctions Issue
• Archive
• Submit News
• About Distinctions
• Distinctions Home

Medical Care and Education Speed Up

Innovations help meet challenges of rapid change in health care nationwide

 

Not too long ago or far away, a patient recovering from gallbladder or hernia surgery would be hospitalized for five or six days, do nothing at home for two weeks, and then maybe return to work after a six-week post-operative checkup.

Now both are outpatient surgeries.

Rapid changes in health care have created challenges for clinical practice and medical education. How The University of Texas Health Science Center at Houston is meeting the challenges was the topic when Richard J. Andrassy, M.D., spoke at the Feb. 23 President's Executive Luncheon.

Major change in academic clinical practice has brought anxiety to our doctors and to our faculty, said Andrassy, who is executive vice president for clinical affairs at the health science center and associate dean for clinical affairs, the Denton A. Cooley, M.D., Professor and chairman of the Department of Surgery at the UT Medical School at Houston. "Despite this, achievements in drugs, technical procedures, surgical technology and understanding human disease have enhanced the quality of life," he said.

"For example, there's a significant trend in surgical services to move toward outpatient environments, both for ambulatory teaching of students and residents and for surgical patients." Advances in hernia surgery, hemorrhoids, thyroid, parathyroid and minimally invasive laparoscopic surgery all decrease hospital stays and cost. "People can go back to work and live a normal life pretty quickly," Andrassy said.

In the case of hernias, development of a special mesh patch has reduced the time required for most hernia repair surgery to less than an hour. "I have allowed most people to go back to playing golf or other types of activities within five to seven days," he said. "I've had some people run triathlons and marathons within a week."

Andrassy has successfully performed about 1,300 of these hernia repairs since June 2002. Performing these procedures at an outpatient surgery center rather than a hospital saves about $5,000 per hernia. With about a million hernia repairs a year in the United States, the savings are huge for health care nationwide.

"It is possible now to do some minimally invasive surgery and not even touch the patient," Andrassy said. With cameras and robotic instruments, "you don't even have to be in the same room to operate.

"Certainly there has been a big shift in the way medicine is practiced and also the way we educate students in medicine," he said.

One innovative way both to educate medical students and residents and to update community physicians on such new techniques is the construction of a Surgical and Clinical Skills Center at the Medical School.

"We need skills labs, simulators and virtual reality so that the resident is not really learning in the operating room," Andrassy said. "This approach has been pioneered by the astronauts and NASA. With the generous support of the Vivian Smith Foundation and the Stryker Corporation and others, we are constructing a facility to simulate problem-based medical training and to reduce medical errors and the time it takes to train residents."

UT faculty have worked to redefine their approach to medical education, focusing more on competency than on the traditional "time-based" training model. With the recent mandate of shorter work weeks for surgical residents, Andrassy said, hospitals, too, will need to make changes, being "weaned off " their reliance on inexpensive residents' services and funding physician extenders - such as physician associates and nurse practitioners - more widely.

By Ina Fried, Public Affairs