Clinics can focus on harder cases as recovery times shorten and treatment options broaden
Professor, to what extent will the rapid evolution in technology change the face of medical care? Today, the practice of medicine bears no relation to the period prior to the 1950s (when intensive care as a concept was non-existent), and hospitals are duty bound to adapt to the new situation. The wonderful achievements in medicine over the last 50 years have cut the mortality rates and morbidity of seriously ill patients. The first milestone was the discovery of penicillin and generally advances in pharmacology, followed by interventional medicine and intensive care. Assisted by technology, intensive care units can keep a person alive on machines that substitute for organ function, until their body kicks back in. It’s also well known that modern laparoscopy techniques for a gall bladder operation, which once needed a 10-day hospital stay, enable discharge from the hospital within 24 hours. A cataract operation, which once required lengthy hospitalization, is now carried out in the outpatients’ department. The same is true of an entire spectrum of simple interventions, such as otolaryngological ones. But even in more serious cases, hospital stays have noticeably shortened. I can give a recent example of the removal of a considerable length of large intestine from a young person. Within three days, he was discharged from the hospital and went back home. Does that mean that hospitals need restructuring? Of course, as is the case all over the world. The new facilities (units, surgeries, etc) need further development as do laboratories, especially the radiology lab, which is the backbone of the modern hospital. First response What is needed are very well-organized emergency outpatients’ departments, which we need to look on as one and the same thing as EKAB (National First Aid Center) units because they provide first response medical care to seriously ill or injured patients. Without a doubt, there has been progress in this country. I would say that even institutionally, we have adapted to the new ideas. However, it’s a huge job. Longstanding attitudes and investment need to change, at great financial cost. Technology has resulted in a veritable explosion in health spending around the world. Can this country meet the challenge? The question of costs in the realm of health is an extremely serious problem. I will give a very simple example. What a cardiologist used to need was a heart-listening device, which cost 200,000-300,000 drachmas. Today, the equivalent is an ultrasound machine which can cost 60, 80 or 100 million drachmas. And it’s not enough to have this machine; many things are needed. Of course, scientific progress has created a new frontier that society cannot ignore. It must find resources from somewhere else and invest in the health sector, if we want to have modern, quality healthcare and save patients’ lives. However, although the cost is massive, I don’t think that it’s the most important problem. What is needed is a change in mentality on the part of both administrators and functionaries in the health service. There is a problem of adaptation – observed both in England and the USA – as classic medicine, centered on the hospital bed, is abandoned. There is a tendency for one of every two beds to be made over to special and intensive care, and post-operative recovery. Isn’t that going too far? In the 1960s, Professor Moulopoulos, a visionary, pioneering doctor, said that the way medicine was going, in the end half the beds in the hospital would be at the disposal of intensive care. At the time, none of us gave this much credence… but that’s where medicine is heading today, at least in America and Europe. England, in the last two to three years, has tripled the number of beds in intensive care units, although, as we all know, it was trying to cut the health service budget for economic reasons. However, they saw there was nothing else they could do. This is the shape of things to come. The whole of the Western world is moving toward the development of these facilities and functions, which contribute to saving people who in the past were doomed. Aspirations Society knows that science can save many of the seriously ill, and is not disposed to forgive our remissness. We are duty bound to fulfill those aspirations, because we are really behind. As I’ve already said, Greece needs another 3,000 beds in intensive care units, that is, non-conventional beds. When you say non-conventional beds, what do you mean? What we mean are [beds in] post-operative recovery rooms, cardiological units, burns and heart attack units, respiratory units, special care units – anything that doesn’t fit the conventional definition of the term for a hospital bed that existed before 1950. All of these units are interlinked. Depending on the severity of the illness, the patient is moved [between one unit and another] so that the system effectively deals with each case. In Greece, there are very few non-conventional beds in intensive care units. And those that do exist are for the highest level of intensive care, that is, for very serious cases. Those few intensive care beds that exist do the work of post-operative recovery. It’s like having a hundred houses with a hundred living rooms, and no other spaces like kitchens, dining rooms, toilets, etc. One room, therefore, one is forced to serve all needs, include all functions. All the other interlinked care units are missing. So there are two dimensions to the problem of intensive care in Greece. One is immediate injury care, which is not always there, and the other, a strategy for restructuring hospitals. The biggest problem at present is that existing intensive care units do not function. We have about 600, of which 150 are shut. But in the units that are open, we have just one-third, or in the best case, half, of the nurses that we need. This the major problem. The solution, however much my colleagues dislike it, is to stop producing so many doctors and hire nurses instead. Greece currently needs 80,000 nurses in order to meet hospitals’ needs. They are the cornerstone… of the health system. For example, I know hospitals that in 1980 had specifications for 1,500 nurses and 20 years later, after all these medical developments, intensive care units, surgeries, etc, nurses number no more than 1,000. There isn’t a single person that isn’t aware of the problem, first and foremost the minister of health, whom I hold in especially high regard. I would say he has single-handedly, like few other people, aided the development of intensive care in Greece. At this moment, I’m not doing anything more than confirming and revealing a problem that he is also aware of. Because it’s a huge responsibility tackling the problem; it belongs to everybody, not just the minister. Would changes in inpatient care result in a drop in the average length of hospitalization in Greek hospitals? Indisputably, when a patient can today undergo operations in an outpatients’ department or in a day hospital… Here, however, something absolutely tragic happens. The patient’s [social security] fund does not pay for a cataract operation or a retina reattachment carried out in outpatients’ departments, but insists he enter the hospital – for which he is charged 24 hours’ stay.
