Cardiac surgeons at the children's hospital is a lack of local specialist title

After the uproar in the children's heart surgery at the Zurich children's hospital, which culminated in the free position of the head, Michael Hübler, as well as the dismissal of an assistant to the physician, the question arises as to the know-how of the remaining Doctors. Both the interim Director as well as to the doctor, not in Switzerland, recognised specialist title for heart surgery. The Kispi refers to the fact that the two Doctors have appropriate specialist title from India (interim head) and Austria (a senior physician). In addition, the Directorate of Health have confirmed that the supply order is ensured with the existing Team.

In the case of the Swiss society for cardiac and Thoracic vascular surgery (SGHC) is critical: "it is not a Person Owns a specialist title, so this may conduct to my Knowledge, only under the supervision of a Person with the specialist title of a procedure," said Peter Matte, Vice-President of the SGHC. The medical Association FMH confirmed. Thus, Physicians are in professional responsibility need, since the 1.1. 2018 for licence to practise a Swiss specialist title or a recognised foreign specialist title.

To evaluated small numbers of cases

René Prêtre, since Hüblers the two Kispi the departure of Doctors, and the difficult heart operations, the interim Manager, despite the lack of a title as a "good surgeon". Across the country there are only a handful of children's heart surgeon, which could lead to a clinic, says heart surgery-the chief of the Unispitals Lausanne; the interim Director is part of it for him.

Prêtre takes the view that two centres for children's heart surgery in Switzerland is sufficient. For today, three locations in Zurich, Bern and Lausanne/Geneva, there are too few cases and too few skilled people. The Zurich children's heart surgery was one of last year 224 cases, in Lausanne and Geneva are operated according to Prêtre every year, around 350 children on the heart, 150 of which come about through the mediation of aid agencies from abroad. The Inselspital Bern is not aware of any case numbers.

Prof. Dr. Peter Matt, Co-chief of cardiac surgery at the Lucerne cantonal hospital and Vice-President of the Swiss society for cardiac and Thoracic vascular surgery (SGHC), manifests itself to the requirements of cardiac surgery in General and to the Situation at the children's hospital in Particular.

Mr Matt, what do you think of that at the clinic for children's heart surgery in Zurich, in Switzerland, a recognized specialist in cardiac surgery is employed?
It amazes me that a hospital for children's heart surgery without according to recognised medical specialists. Actually, it would, of course, that someone who operates alone, in a patient's heart, has a Specialist for heart surgery. I find this unusual.

operators are obliged to have a specialist title?
Those who operate alone: for sure! In Basel, where I was trained, you could be only with the Specialist for heart surgery, a senior physician.

Are there any legal or state regulations, which state that only is allowed to operate, who owns the specialist title?
the awarding of The specialist title for heart surgery by the FMH is confirmed, the qualification of a Person to carry out a heart surgery. A Person does not have such a specialist title as these may carry out – to my knowledge – only under the supervision of a Person with the specialist title of such an intervention. There is, therefore, quite legal, respectively, state-law regulations for the implementation of a cardiac surgery.

What are the requirements for a specialist title?
In Switzerland, you must first complete two years of General surgery, with training in various General surgical subjects, also in anesthesia and intensive care medicine. Only then can the actual heart surgical training begins. This usually takes four to six, sometimes even eight years, in which one learns how to operate a heart. Then, first the European specialist title, and only after that you can drop the Swiss specialist exam. The primary is the specialist title for adults-heart surgery, but there is still a European, is specially designed for children-heart surgery.

this Means that in Switzerland there are no Specialist children's heart surgery?
no, this title. There is only one specialization in pediatric cardiac surgery. This is something special.

When children play, for example, congenital heart defects, a very large role, much more than in adults.
Yes, that's right. In adults, we have other diseases, age-related wear and tear of the heart valves, for example, to the coronary vessels or the aorta. In children, there are often structural problems that have this heart.

What is the role of surgery of congenital heart defects play in training to become a specialist?
There are simpler heart defects in children, diagnosed only later in adulthood. These are, for example, small holes in the heart between the Atria or the main chambers. This one needs to be able to in adults to operate, in order to receive the specialist title.

How many operations you have to have to obtain a specialist title?
The total of about 100 to 150 heart surgeries, under the supervision of well-made. Only then you can apply for the European specialist examination. But only in theory. For the Swiss specialist title it is necessary to operate in front of experts. There were also Doctors who have not passed then.

That sounds demanding.
Yes, absolutely! The title of doctor for heart - and thoracic vascular surgery is one of the most demanding.

Where learns as a specialist in cardiac surgery, the surgery severe congenital heart defects in children?
To learn heart surgery to centers where there are high numbers of cases. This is in Switzerland, there is a Problem. In Germany, France or England, it just has a lot more heart patients. Therefore, many cardiac surgeons are going for a certain amount of time abroad, to have the appropriate skills. The large centres in Germany, up to ten times more operations than the centers in Switzerland.

Like a modern heart is the centre?
At a heart center, it goes to the following: A child or an adult comes to the hospital and through various stations and then continues in the heart. First the diagnosis, then treatment, and finally follow – up on in the ICU, in the hospital or at home. All can not afford a trade in the direction of alone. Therefore, the heart is the center from Physicians of various disciplines. The Tricky part is the professional cooperation, and communication. The ideal way to pull all in the care of the patient on the same rope. This is not always easy. It is important, therefore, that those responsible have a high-quality education, and similar views for the treatment. Before we operate the patient, we need to know what you want to achieve.

In Germany, there are guidelines on how a children's heart surgery organized is a must. There is something similar in Switzerland?
Our guidelines are often developed in cooperation with the German society. How it behaves in the particular case of children's heart surgery, I don't know, but very often, we work closely together.

How many operations it should perform a cardiac centre in order to ensure a certain quality standard?
For the children's heart surgery, I can't say it exactly. In adults, it should be 300 to 500 operations per year. The only way you can guarantee that the patients are well taken care of. In Switzerland this is not the case everywhere.

The German guidelines call for a separate intensive care unit, which is only for the heart centre. How does it look like in Switzerland?
20 years Ago, we had intensive care units for heart surgery. Today we have a rather large intensive care units with different patients. Since the specialization is missing. In the future, it is likely to be back again in the direction of specialized intensive care units. Because the procedures have become so complex, it takes a certain amount of specialisation, be it for the heart or for other high-end medical procedures.

Back to children's hospital. There, the children's hospital contested the allegation is that the current interim Director have added to the redundant medical assistant A. S., the joint Operate repeatedly stab wounds. How often injuries between the operators?
Very rarely. If it even happened on purpose . . . so this is something I've never heard of or experienced. Unintentionally, it can happen very rarely. Finally, we are working with sharp instruments. (Editorial Tamedia)

Created: 25.04.2019, 06:31 PM