Collegues on Ålö (Eel Island)
With good dinner in a cosey cabin, discussion was focused on the last years development in the organisation of surgery in parts of the western world.
In the industrial world large-scale operation has been the trend for decades and big companys "eat" the smaller. This has also become fashion in the medical establishment and since the nighties ,hospitals are run like Toyota factories (the Lean model has actually been used as a management model for some Swedish hospitals).
Centralization is also a part of large-scale operation and many surgical procedures have been centralized to large-scale operation hospitals where parts of my profession dream of creating "Centers of Excellence". Those who are in favour of centralization argue that quality improves and politicians probably hope for lower production costs. A fact is that quality improvement (except for very advanced procedures) has never been shown in our qualityregisters (where Sweden is allways top five among the OECD countries) with centralization, but what we do know is that waiting time increase also for cancersurgery. Moreover surgeons on county hospitals loosing elective surgery because of centralization will be less fit to handle emergency procedures where often extensive experience is needed.Since our county hospitals are due to perform emergency surgery 24/7/365 it all ends up being a Catch 22 situation, an interesting fact in our times of increasing conflict between urban and rural areas.
In line with large-scale operation,centralization,and "centers of excellence"is also our time specific symtom of narcissism and lack of humbleness. Google´s "superfuturist and megainnovator" Ray Kurzweil claims that ethernal life is near. Year 2030 we will inject billions of "nanorobots" into our bloodstream and these robots will cure us from cancer ,autoimmun diseases and ethernal life is within reach. The ones believing this should read the Tower of Babel, a biblic metafor based on thousands of years of human wisdom on the topic of hubris and it´s consequencies.
I resigned 2015 and my most senior collegue Marie Uddenberg(on the picture) took over leadership of gastrointestinal surgery. Since then I have been employed on a hourly basis,contracted to perform all rectal cancer surgery.
Rectal cancersurgery is a demanding procedure and allthough having good results in our national qualityregister,we have now been ordered to forward all rectalcancer patients to a "large-scale production" hospital. Performing one of our last rectalcancer procedures my daughter (who is half way through medical studies) took a break from lectures and books and participated in real life for a change.
Future will show us wether patients handled like Toyota cars will be satisfied or if there will be a backlash for centralization.
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