Thursday, September 19, 2013

"Boom Baden-Baden" Day 4- "will that be all your highness?"

After all the excitement of yesterday, I was tired all day today. 

We showed up for the morning meeting at 8 again. This morning we discussed a poly trauma case from last week. Guy fell while climbing and basically broke every bone in the upper spine and rib cage that was possible. 

Then we dispersed again. It was my day to be with Dr.D. We looked at a few cases before leaving for the private hospital. 

The car ride there was gorgeous. The scenery really is unbelievable. Right along the Black Forest. The little towns had beautiful fachwerk houses with pink flowers hanging from the balconies and along the railing along the water. The towns look like the setting of old fairytales. The ride up the hill was long and winding through the Balck forest. Germany truly is the land of fairytales. Snow White probably lived right around the corner and her friend Cinderella was chillin in Schloss Neuschwarnstein (where I will be tomorrow). I would really enjoy living in this area for a while. I think it is especially nice for kids.

The private hospital is located on top of the hill. Driving up the winding, tree lined alley certainly didn't feel like the concrete pavement that takes you up to our hospital in G√∂ttingen. The hospital is inside of what looks like a hotel. If it weren't for the few doctor rooms and exam rooms, it would be a hotel. The lobby is large and spacious with a winged piano and velvet seats. There is a reception area, a pool, a golf course, fitness studio, sauna and more. There are two suites situated at the top of the building each about 100 square meters large. The "patients" can either enjoy the dinner in the dinning area or if you are too famous or don't want to mingle among others, you can have your food served to your room with lovely silver bells covering it (like in the super fancy hotels in movies). 

The medicine practiced here is very different than that in a "normal" hospital. Here, the "patient" really is king (and sometimes literally are). They want it? They get it? Medically necessary....maybe not, but they are paying customers. I feel there are two kind of patients that visit the hospital. One group really is sick and maybe too famous to get good, quiet help or sick and can get better care in Germany than in their own country. And then there is the group that just has the money and wants to have a full body CT or MRI. They turn into somewhat of their own doctor. They think they know what they need. If they pay enough, they get (almost) everything. Lets just say there is hardly a German name in the mix (unless they are royal, famous or filthy rich). Historically, Baden-Baden is very well known in Russia. The Zars would come and visit there and in more recent times (although there aren't Zars) come for their medical care. There are also a lot of people from the Middle East. Because of all the international patients, there is also a good business for translators. I read one doctors letter that started with, "your royal highness, we allow ourselves to report to you about your stay with us in our hospital..."

As a doctor in this hospital you almost purely provide a service. I don't have a problem with people having a full body MRI if they have the money and are interested. The issue with that is that the risk of being over treated with all the "pathological" things you find is high. I do however have a issue with patients requesting CAT scans for their abdomen and thorax. If its medically indicated, no doubt, do it if there is no alternative. But for the hell of it? I think many just know it exists but don't know how many rays they are exposing themselves to (which heightens the risk of developing ray induced tumors). They didn't study medicine and have the necessary hours to make the right indication for a CAT scan but yet they demand it. In the end, whatever. If I was the doctor and made the risks very clear to them and they still wanted it and are paying the money they should go ahead and fry themselves. I just won't be the doctor doing it.

I do think this hospital is a nice option if you are filthy rich and sick and want a relaxing, quiet place to get your treatment. The view is amazing and I hear the wine and champagne list has the finest.

The coolest diagnostic thing we did today was a virtual colonoscopy. You might think its for people who don't want anything going in the backside but you are wrong because they don't get around that. The correct medical indication for a virtual colonoscopy is if a normal colonoscopy is not possible due to blockage. The patient still gets a probe inserted and the intestine is inflated with air. Then the patient is sent through the CAT scan. The disadvantages to the normal way are the ray exposure and the inability to take a biopsy directly while performing the exam.

After the scan is processed in the computer, it is reconstructed 3D and you can navigate the colon. It looks like a video game.

The other exams were x rays and MRIs. I didn't see anyone being really sick. One had a slipped disk that might be giving the patient some trouble but she indicated pain on the opposite side of the slip. The slip could have been purely coincidental.

It was definitely an interesting day up there. Our lunch was so-so. Of course we weren't eating the 5 star menu. We are the working personal. Anything not in the sight of the customers doesn't look any kind of special. Everything they see looks glamorous. 

Once back in the real world, PKay and I made our way to the trains station and headed to Munich. 

Hopefully the relatives I'm staying with have wifi and I can post a bunch of pictures tomorrow!

Baci, V

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