Cesar Athié,
Director General
Hospital General de México
View from the Top

Health Education for Doctors and Patients

Wed, 09/07/2016 - 12:57

Q: How is the General Hospital of Mexico managing challenges from the industry?

A: The hospital is a grand example due to its huge size, 45 specialties and unique three level division. Primary care is emphasized on the first floor where general doctors diagnose patients and refer them to the more specialized second and third floors or specialty clinics. The second level treats 90 percent of the most frequent pathologies while the top floor oversees the remaining 10 percent, reserved for the most complex conditions in need of medical surgeons. The hospital has a heavy surgical load and we handle all types of cases. Disease is managed mostly through medical care and complemented by education and research.

We take pride in the quality our hospital offers and work hard to keep up with medical innovation that can improve our services. The health sector is constantly undergoing changes thanks to the evolution of illnesses and the consequent adaptation of treatment.

Curative and preventive medicine have equally experienced dramatic shifts, which make the transition that much more difficult. As our budget is quite limited, we prefer to invest in curative medicine to avoid expensive complications. Technology is another challenge as equipment quickly becomes obsolete. We find that renting equipment makes much more sense than buying it. It is a cost-effective method that keeps our devices up to date.

Q: How has Hospital General maintained its quality in a landscape brimming with budget cuts?

A: Our income comes from the federal budget, Seguro Popular and other agencies. We receive an abundance of support because the hospital manages the biggest chunk of the pathological cookie in Mexico. Some of our cases and convalescence rooms are covered by Seguro Popular. We offer important qualitative and quantitative information as our size and the number of cases we treat give an accurate glimpse of what is happening in the country when it comes to health.

The hospital also receives external support from visionaries who grant donations on their own or upon request. Some lend a hand by buying or renting our equipment. For instance, patients that undergo kidney or liver transplants receive support from the Carlos Slim Foundation, which sponsors subsequent costs.

Q: Mexico spends 6.2 percent of its GDP on its healthcare system, yet only 8-10 percent is assigned to medicine and administrative expenses carry the biggest weight. What is being done to prioritize patients over administrative processes in the HGM?

A: The organizational structure of the hospital is constantly under revision and modernization. New technology is an important piece of the puzzle that lessens administrative hassles. The changes in our system reap higher rates of productivity and quality. We are constantly evaluating and receiving feedback to assure best practices. Our three levels of care and specialties are molded according to the needs of the country and our patients, which are constantly changing. Hospital General also gives human resources priority as it straightens out the dents in medical care. Accurate diagnostics and adequate treatment are essential to minimizing complications, which can only be achieved with a coordinated and prepared staff.

We are starting to focus on minimally invasive surgery as it is the largest type of surgery in the hospital, particularly laparoscopic. Our studies found that patients are in need of smaller hospitals. We are finding ways to optimize our patients’ stays and save them time. The new buildings and towers are starting to be managed as outpatient areas and short-stay areas for minimally invasive surgeries.

Q: What strategy does the hospital use to attract the best qualified surgeons, considering the health industry suffers from a lack of doctors and nurses?

A: Hospital General has no issues when it comes to specialized doctors, as it handles their training through UNAM, the IPN and other private universities. Depending on the needs of the hospitals, we even send doctors to be educated abroad.

The real issue is the availability of specialized nurses, a worldwide conundrum. Our best nurses are prepared inside the hospital at a school we hope to expand. We also have general nurses that jump from being trainees to professionals. Unfortunately, Mexico is experiencing a drain of nurses to Canada.

Q: How does the Hospital emphasize the importance of general doctors?

A: Our entire first floor is dedicated to general doctors that form part of our training program. Many do not have enough expertise and we help them become family practitioners. Afterward, we focus on internists who are doctors with a higher level of preparation. From this group, cardiologists and heart surgeons among others, are trained.

The hospital avoids many problems by developing its own experts through training cycles with the help of its modern infrastructure. The relationship has mutual benefits as the doctors grow professionally and pass on their knowledge to the hospital’s 782 medical residents.

The hospital makes sure to prepare itself by equipping its general doctors with enough knowledge to serve efficiently on the first floor. We have plenty of specialists and worry more about having trained staff in primary care, as incorrect evaluations can cause a hurricane of complications, and costs. Improving the quality of primary care is vital.

Q: Recently, MX$730 million (US$38.8 million) was invested in a new surgical tower and the development of other new cardiology and rehabilitation units is being financed. What other expansion plans is the hospital considering?

A: The Hospital General de México is 111 years old. The hospital has European origins and when it was created in 1905, the tendency was to develop horizontal clinics. In this century, horizontal buildings are inefficient and the hospital is pushing toward verticalization. The first tower was for oncology, the second for surgery. We are working on finishing another three by the end of the year. A project is also being developed to sew together the units with their associated services. We made sure that construction did not obstruct the flow of the Hospital by relocating the staff to other sections to continue operations. The advantage is we have better installations and surgeons.

Q: How would you describe your most outstanding success stories?

A: The hospital considers rehabilitation cases to be some of the most outstanding, especially if the patient is young and has a bright future. Complications are always a possibility. The loss of a body part requires transplants, an extremely difficult procedure that is now possible thanks to our new equipment. Some patients have critical pathologies like placenta accreta, a condition where the placenta attaches itself to the uterus. It can cause uncontrollable bleeding and has a high mortality rate. We have learned strategies that minimize risk in these cases. For instance, a small caesarean incision can take out a product that is passed to interventional radiology, while leaving the placenta attached to the uterus. The arteries that feed the uterus are then treated to stop the bleeding and remove the entire uterus without losing more than one liter of blood, ultimately saving the patient’s life. Pregnancy complications are a challenge in Mexico as premature pregnancy is a health epidemic. Our latest case involved a nine-year-old girl from the streets.

Q: As a main teaching hospital in Mexico, what is the role of education in medicine and how can the public and private sectors collaborate to promote more academic participation?

A: The hospital believes that a country cannot grow without education, particularly rural areas that lack services. Paradigms need to be broken to allow comprehensive educational programs. Education can solve many problems within Mexican society such as obesity, hypertension and diabetes. The health sector can help by offering tools and improving quality of life for the general population. We receive many patients with advanced cases of breast cancer that could have been prevented.

At HGM we run a patient university, a program inspired by places like Barcelona and Stanford where patients are taught self-care practices for a wide variety of illnesses. We place them in classrooms so that they can share information and experiences in pairs, similar to AA groups.