Your Life Your Doctor

By Stephan Schlunke

• Have you always wanted to be well informed when consulting your physician?
• Have you struggled to find THE doctor that best suits you?
• Do you want a hint (actually a sustaining system from the pro) on how to help your doctor to avoid errors?
• Do you believe it is high time that our world (especially the medical world) stopped being "a man's world"?

Then, this book is for you! It originates from the wish to ease the relationship between patients and physicians, helping both worlds unite in thriving for the best potential outcome. We will explore the formation of the human ego and the importance of touch during our growth, we will discover how the patient and their relatives can help doctors avoid cognitive errors - our ego being a leading generator of such errors and a bias to our perception of reality.

We will then compare the health care scenario to the progress made in the aviation industry. Forty years ago, pilots found themselves in a similar situation: the heroic times of pilot idolization were fading away, carrying with them their ego as well. Today, pilots and crew members have learned the power of thanking those who draw attention to an error or mistake, an attitude that the medical field would undoubtedly benefit from.

In this scenario, the patient and their family could represent the physicians' co-pilots, and the operating team should act as the surgeon's co-pilot in the operating theater. Our checklists act as support in order to choose YOUR Doctor and not to omit anything important during the doctor's visit.
Just like aviation implemented Crew Resource Management (CRM) and crew selection procedures to achieve a change of behavior in cockpits, the author will suggest pre-med-school and specialist selection tools; finally you will find checklists with questions that the patients and their relatives can use to help physicians think - think and act correctly.

A link to downloadable checklists is provided corresponding to those at the end of the book. The website works on computers and portable devices of all types (Google / Apple / ...), directly online or even off-line after a small download. These are very easy to use checklists intended to help you and your doctor during interview.

• Language: English
• Publisher: Stephan Schlunke
• Release date: Jun 28, 2021
• ISBN: 9791220087506

Book preview

Preface

ARE YOU READY? ASKED the young man to his father, helping him close the protective coveralls they had to use to enter the room of a Covid-19 patient. Their eyes met through the face shields, and the smile of their gladness was perceivable despite the mandatory face masks. 

If it had not been for the virus, Frédéric Schlunke and his father Stephan, a consultant at the Moncucco clinic in Lugano (a non-profit organization[1] in south Switzerland), would never have had the opportunity to work together! The former is an economics and business student at Bocconi University in Milan and his father is a general and vascular surgeon, active for over 25 years in the field with over 15000 surgical procedures performed since the end of his internship in 1998. 

The two entered room number 110 together. Because the Swiss Army had drafted Frédéric to support staff work on hospital wards in the Moncucco clinic of Lugano, where the Covid-19 infected people would be sent, both were called to act on the same patients. Lugano is the most populated town of Ticino, Switzerland's Italian-speaking area, which is only 70 km North of Milan - Bergamo, one of the largest Italian centers of the viral outbreak in spring 2020. 

The compassion encountered in the relationship between nurses, medical staff, administrative employees and this extemporaneous flood[2] of patients was eye-opening, and it partly caused the genesis of this book. 

The peculiar state of isolation of the patients—no relative, if not in exceptional situations, was allowed near them—and the substitute family that the care team compassionately offered them was extremely touching. It led medicine to win its primary goal back: making people feel better, even in the face of ineluctability. 

This book originates from the wish to ease the relationship between patients and physicians, helping both worlds unite in thriving for the best potential outcome. Via an excursus about the formation of the human ego-system and the importance of touch during our growth, we will discover how the patient and their relatives can help doctors avoid cognitive errors—our ego being a leading generator of such errors and a bias to our perception of reality. 

A possible solution could already be provided by the aviation industry. Forty years ago, pilots found themselves in a similar situation: the heroic times of pilot idolization were fading away, carrying with them their ego as well. Today, pilots and crew members have learned the power of thanking those who draw attention to an error or mistake, an attitude that the medical field would undoubtedly benefit from. In this scenario, the patient and their family could represent the physicians' co-pilots, and the operating team should act as the surgeon's co-pilot in the operating theater. The essential premise for this scheme to work, though, is that physicians accept patients and the operation-team as their peers, their equals. Just like aviation implemented Crew Resource Management (CRM) and crew selection procedures to achieve a change of behavior in cockpits, the author will suggest pre-med-schools, specialist selection tools and checklists with questions that the patients and their relatives can use to help physicians think—think and act correctly. 

At the beginning of the pandemic, the Moncucco Clinic did not yet have dedicated iPads or tablets to help patients communicate with their families. Therefore, nurses and doctors would frequently lend their private cellphones to bridge the gap between elderly patients and, let's say, their grandchildren. This same staff would then have to stay on one side of the border, sleeping in hotel rooms—organized by the Clinic—for several weeks, without seeing their own families and children on the other side, if not through the same (sanitized) cellphones. A surreal situation that saw light because many Swiss hospitals on the border cities (Basel, Geneva, Lugano, etc.) often rely on the convenient working force from the other side. 

Many physicians and other health care workers know from childhood on what their fate and life goal will be: to become a doctor, a nurse, a psychologist. Some follow that path because a family member has been an ex-ample for them, some others do it after personal experience or even after a personally experienced illness in their family or on their own skin. However, most health care providers chose this path be-cause of a need for compassion, and because of the unique emotion of satisfaction that altruism pays us back.

And so it was for the author. He did not have family members active in the hospital field (three generations of chemists preceded him). However, he experienced some relevant events in his childhood... although not more relevant than those each of us has had to endure! As we will see later on, in a chapter dedicated primarily to surgeons’ EGO, our childhood experiences are of most considerable importance to determine the formation of our character. Schlunke had the opportunity to attend several workshops and retreats of the LEO-institute, which changed his way of looking at events forever! [3]

Since the very first years in the surgical field, he started noticing the disparities between colleagues and their different behaviors in the operation theatre, with patients and with other physicians or nurses. The dream to become a surgeon overwhelmed him at a very young age and he quickly encountered mentors who made him say: «One day I will be and behave like them. Namely, I want to thank Dr. Guido Von Allmen and Dr. Diego Donati. »

I want to learn to fix people - I want to become a surgeon, a passionate surgeon.

His elementary school teachers remember him saying this since age 8. He grew up in French-speaking Switzerland, but being a German native speaker and initially, until his 12th birthday, also a German citizen, he soon began being bullied by his fellow first-graders: you are an SS! Which ironically corresponds to his initials... 

It was not until German history and World War II became a school topic that he started understanding the abhorrent behavior of the Nazi regime. Slowly, but steadily, the conviction grew in his child's Weltbild: I have to do something to make up for the atrocities that my ancestors did to humanity. I want to learn how to fix people...I want to become a surgeon, a passionate surgeon!

A WELL-KNOWN NOVEL by Samuel Shem: The House of God, published in 1978, describes the first internship year of young doctors and medical interns in a fictionalized—but probably personally experienced—New York hospital in the early 1970s. Even then, the depersonalization and psychological harm endured by the majority of residents seemed the only way to obtain a passport to the world of medical freedom—meaning to become an independent specialist: 

« The House of God had been founded in 1913 ... had broken down into many hierarchies, at the bottom of which lay the very people for whom it had been constructed, the House Staff. Consistently, at the bottom of the House Staff lay an intern. »[4]

During his career to become a surgeon, Schlunke made the conscious decision of never to bully any of his fellow assistants; but he created instead opportunities and conditions for the younger colleagues to learn and evolve in a peaceful and sustaining ambiance. During several years as vice-chair for surgery in the hospital of Locarno, Switzerland, he started managing the surgical ward together with his former superiors, Dr. Paul Biegger and Dr. Diego Donati, achieving a familiar and stimulating atmosphere for the entire team.

They found hospital La Carità to be the best Swiss hospital in its class in a study commissioned by the Swiss consumer association about patient satisfaction in 2007 [5] (I apologize for the chart and illustrations missing, as they could not be embedded by the publisher in a similar way you can find them in the paperback version).

In 2008, Locarno La Carità became the first Swiss hospital[6] to get full accreditation by the Joint Commission International (JCI). On this occasion, Schlunke had the privilege to contribute firsthand to implementing the time out procedure in the OR[7]; furthermore, he had the chance to directly address the surgeons' disruptive attitude by demonstrating in an ironic video how this type of behavior could lead to severe medical errors. (The footage obtained the first prize at the European vascular surgery convention in Athens, 2011). 

The Speak up campaign by the JCI (2002 and 2018) and Schweizer Stiftung für Patientensicherheit (2015)[8] would validate the efforts made through those years.

In the JCI [9]certification process, some evidence became noticeably clear to the whole staff: allowing people to speak up and even encouraging a critical incident reporting system (CIRS) is of immense value when aiming for the quality elite. However, the system only works when every single person, from the ground up participates, encouraging them to speak their minds. Therefore, just a fear-free environment allows real qualitative growth. [10]

One of the slides used in Schlunke’s motivational talks quotes: Good surgery is made where a scrub nurse can stop a surgeon! Your hospital is excellent if your nurses are free to stop a doctor or a surgery administrator! In Schlunke’s own ironic words: At home, my scrub nurse—my wife—stops me whenever she feels like it! Just with a snap of her fingers! 

Good surgery is made where a scrub nurse can stop a surgeon.

After having experienced the results and the well-being of health-care workers, administrators and patients in a hierarchically flat system, Schlunke’s additional objective was to get the best working conditions for the folks at the bottom: the gratification of working in such a flat organization is immense and therefore leads to better results.[11]

Most of the time, simple steps lead to great outcomes: in the Checklist Manifesto, Atul Gawande[12] could seamlessly demonstrate how a simple surgical checklist can dramatically diminish complications and provide an exponential gain in quality. We observed this change not only in the facilities located in developing countries, where everybody expected to notice its major impact; it also proved to be effective in institutes like the Massachusetts General Hospital. The same has happened in Locarno’s Hospital La Carità, where the checklists have also been implemented. At the same time, only a stone’s throw away, medical residents are still bullied today. 

The medical world has yet to learn!

ONE OF THIS ESSAY'S objectives is to elaborate useful and straightforward tools, bringing a renewed awareness to patients and colleagues; not to blame them, but with the intent to co-create a better medical world. Therefore, we will explore what to expect and eventually how to choose, with a reproducible approach, the ideal physician for your specific condition. 

When facing the urgent need to find the best solution to a personal health problem, the quest for many of us is to locate the adequate specialist capable of solving our condition, or at least able to help us cope with it. 

HOW CAN I FIND the competent and compassionate professional for my health problem?

What are the most pressing issues patients deal with when having to undergo surgical treatment? Most of the time, the patient turns to their family doctor, friends, and relatives asking: do you know a good surgeon? or how can I find the competent (and compassionate) professional for me? 

Some people, like our writer’s wife actually, have a strong opinion on such an emotional subject. In her own words, she does not care if the surgeon is a pleasant person. She needs two skillful hands and a proficient perception! If you have two left hands with five thumbs, you should not touch patients... However, being a former scrub nurse, she knows how to evaluate the expertise of a physician! 

At the