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1 3 - Cómo Este Médico Está Cambiando El Campo de La Ortopedia - TRADUCIDO Oct2022
1 3 - Cómo Este Médico Está Cambiando El Campo de La Ortopedia - TRADUCIDO Oct2022
com/c/MSmAdqfH/1085-786641123-translation-translate-
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Artículo a traducir:
https://disruptmagazine.com/how-this-doctor-is-changing-the-field-of-
orthopedics/
Dr. Alejandro Badia had a long history of medicine from his family in Cuba. As an
immigrant kid in New Jersey, he was partly raised by my grandparents, who lived
adjacent to him since his parents were doing what he calls “the immigrant shuffle.”
“My parents were working long hours, and my dad was restarting engineering
school at NJIT in Newark,” said Badia.
“I spent much time with my paternal grandmother, from Valencia, Spain, who had
truly debilitating rheumatoid arthritis. I recall when she had her knee surgery (I think
a replacement) and later, when I was only eight years old, accompanied her and my
grandfather to see a hand surgeon in NYC at Columbia-Presbyterian.”
This hand surgeon turned out to be Bob Carroll, one of only two hand surgeons at
that time since it was a burgeoning specialty. “Well, 20 years later, I learned that my
main mentor, Joseph Imbriglia, would later train under this mentor. Dr. Carroll was
essentially MY grandfather of hand surgery.”
That experience was etched in his mind as he read “The Making of a Surgeon” at
age 11 and later again at 16 before applying to college premed programs. “Despite
my modest public school education, I managed to gain acceptance to Cornell, and
the rest is history,” he said. “I was involved in a research study at Cornell Med in
NYC, where I had to perform microsurgery on a rat carotid artery. I realized I had an
affinity for working under the microscope. Later, while at NYU med, I saw that
Orthopedics was the specialty that best suited my personality: fast-paced, the ability
to truly cure people, and undergoing a major wave of innovation. There was also an
affinity to fitness and sports suited my lifestyle”.
During his surgical residency at the famed Bellevue Hospital, where the author of
“Making of a Surgeon” book also trained decades earlier, Dr. Badia confirmed his
specific interest in surgery of the hand.
Emergency Rooms Are Not Always The Answer For
Emergencies
After years of experience in the field, Dr. Badia concluded that sometimes a
traditional emergency room could cause more harm to a patient than good when
helping them with an orthopedic injury.
“The problem with emergency rooms is that they are not ideal for fewer injuries or
certainly complaints of joint pain, for example,” explained Dr. Badia. “They are
focused, as they should be, on treating that patient with chest pain, asthma attack, or
anaphylactic shock, for example. They are well suited for major injuries such as a
femur fracture or spinal cord injury, but ankle sprains, wrist fractures, and shoulder
pain go to the bottom of the triage list.”
The issue is, Dr. Badia explained, that this does not only delay the patient receiving
the appropriate expert care from the right orthopedic specialist but in many cases,
the diagnosis is missed. This is because subtle issues are not in the domain of the
well-rounded emergency room doctor, who cannot be an expert in everything.
And further, “The cost to our healthcare system and society is yet another issue that
deserves its discussion,” he continued. “Let’s keep in mind that US healthcare is
approaching 20 percent of our GDP. That is twice the rate of the next industrialized
country on the list, Switzerland.”
In short, Dr. Badia believes that we must evolve in delivering care for patients and
not just focus on the next high-tech advance. And so, he knew finding a sustainable
solution for his community in Florida was necessary.
The Creation Of OrthoNOW® Doral Immediate
Orthopedic Care Center
In 2010, Dr. Badia’s frustration with the health care system sparked the idea for the
creation of specialized orthopedic urgent care centers to efficiently assess and treat a
range of orthopedic and sports injuries. OrthoNOW is an immediate orthopedic care
center where everything from acute injury to pain is addressed in virtually any
musculoskeletal condition.
The few exceptions are major injuries in patients who cannot ambulate, such as a hip
fracture in the elderly. While OrthoNOW is certainly not “new,” in terms of ideas,
Dr. Badia still had to be quite innovative in creating community engagement and
facilitating a behavior change.
“The problem has simply been that the local hospital systems have no interest in this
succeeding, and even the insurance companies, who most stand to benefit due to
cost, are not engaged since their salaried employees are not interested in change,”
explained the doctor.
“However, I founded this concept because nearly every patient who saw me in my
hand and upper limb practice, Badia Hand to Shoulder Center, had been somewhere
else first- and that place did very little to diagnose the problem, let alone fix it. This
includes the primary care doctor, general urgent care, and the busy and expensive
emergency room.”
“In fact, many times that person would gain an appointment with the recommended
orthopedic surgeon only to be told, ‘I do knees but don’t know much about the
wrist.'”
OrthoNOW sorts all this out and uses their award-winning app to communicate in
real-time to the right sub-specialist as one cannot expect a foot surgeon, knee
surgeon, spine specialist, hand surgeon, etc. to all be sitting in a walk-in clinic,
waiting for the appropriate patient to walk…or rather… limp in.”
This is a simple concept, yet the public has, until now, failed to grasp it, unlike
Uber, Tinder, or some other app from a phone.” This is the reason we recently went
to market since a large healthcare company, innovation-minded, is needed to take
this national, and even international,” said Dr. Badia.
The Highs & Lows Of Orthopedic Work
Of course, any dedicated professional’s job will come with specific stresses–
amplified when that work is centered around human health. But much of the lows
from Dr. Badia’s work have more to do with the hurdles to success: “The most
challenging part of any American physician’s job is the ubiquitous interference in
our decision-making process and ability to practice medicine without barriers and
hurdles,” he said.
“Without even mentioning the declining reimbursement, relative to our increasing
overhead expenditures, the lack of control has frustrated me the most. I believe my
colleagues, leading to the term ‘burnout.’ I can’t entirely agree with that term and
prefer to use the phrase, ‘Moral Injury’ as first coined by Boston colleague and
surgeon, Dr. Simon Talbot.”
Dr. Badia discusses this in his book, Healthcare from the Trenches. He still hopes
there may soon be political will to improve this situation as many physicians are
retiring early or extensively modifying their practices, like himself.
“The doctor’s most rewarding part of my job is likely what most physicians would
attest to- the ability to truly impact the life of a fellow human being,” says the
doctor. “The exceptional cases I have had the privilege to address are always with
me, and an insurance executive could never take them away from me. The ability to
impact a stranger’s pain and function in a country where they otherwise would not
have that access is a cherished privilege. This reason is why many of us participate
in medical missions. I have done missions in Guatemala, Ghana, and Bolivia. I am
currently organizing one for a European group in Ecuador. GICAM wants me to
head their Latin American operations due to my language and vast travel experience
to nearly all these countries over the past 25 years.” Like all his professional
accolades, Dr. Badia embraces this opportunity.
Cómo Este Médico Está Cambiando El
Campo De La Ortopedia
El Dr. Alejandro Badia tiene una larga historia de medicina, desde que su familia
vivía en Cuba. Como niño inmigrante en Nueva Jersey, fue criado en parte por sus
abuelos, que vivían junto a él, ya que sus padres estaban haciendo lo que él llama
"la baraja de los inmigrantes". "Mis padres trabajaban muchas horas, y mi padre
estaba reiniciando sus estudios de ingeniería en el NJIT de Newark", dice Badia.
"Pasé mucho tiempo con mi abuela paterna, de Valencia, España, que tenía una
artritis reumatoide realmente debilitante. Recuerdo cuando la operaron de la
rodilla (creo que de una prótesis) y más tarde, cuando sólo tenía ocho años, la
acompañé a ella y a mi abuelo a ver a un cirujano de la mano en NYC, en el
Columbia-Presbyterian".
Este cirujano de la mano resultó ser Bob Carroll, uno de los dos únicos cirujanos de
la mano que había en aquella época, ya que era una especialidad incipiente. "Pues
bien, 20 años después, me enteré de que mi principal mentor, Joseph Imbriglia, se
formaría más tarde con este mentor. El Dr. Carroll era esencialmente MI abuelo de
la cirugía de la mano".
"El problema de las salas de urgencias es que no son ideales para lesiones menores
o ciertamente quejas de dolor en las articulaciones, por ejemplo", explicó el Dr.
Badia. "Se centran, como debe ser, en tratar a ese paciente con dolor torácico,
ataque de asma o shock anafiláctico, por ejemplo. Son muy adecuados para
lesiones importantes, como una fractura de fémur o una lesión de la médula
espinal, pero los esguinces de tobillo, las fracturas de muñeca y el dolor de hombro
van al final de la lista de triage."
El problema, explica el Dr. Badia, es que esto no sólo retrasa que el paciente reciba
la atención experta adecuada del especialista ortopédico correcto, sino que en
muchos casos se pasa por alto el diagnóstico. Esto se debe a que los problemas
sutiles no son del dominio del médico de urgencias, que no puede ser experto en
todo.
Y además, "el coste para nuestro sistema sanitario y la sociedad es otra cuestión
que merece su debate", continuó. "Tengamos en cuenta que la sanidad
estadounidense se acerca al 20% de nuestro PIB. Eso es el doble de la tasa del
siguiente país industrializado de la lista, Suiza".
Las pocas excepciones son las lesiones importantes en pacientes que no pueden
deambular, como una fractura de cadera en los ancianos. Aunque OrthoNOW no es
ciertamente "nuevo", en términos de ideas, el Dr. Badia tuvo que ser bastante
innovador para crear el compromiso de la comunidad y facilitar un cambio de
comportamiento.
"El problema ha sido simplemente que los sistemas hospitalarios locales no tienen
ningún interés en que esto tenga éxito, e incluso las compañías de seguros, que son
las que más se benefician debido a los costes, no se comprometen ya que sus
empleados asalariados no están interesados en el cambio", explicó el doctor.
"Sin embargo, fundé este concepto porque casi todos los pacientes que me veían
en mi consulta de manos y extremidades superiores, el Badia Hand to Shoulder
Center, habían estado primero en otro lugar y ese lugar hacía muy poco para
diagnosticar el problema, y mucho menos para solucionarlo. Esto incluye el médico
de atención primaria, la atención general de urgencia y la concurrida y costosa sala
de urgencias."
"De hecho, muchas veces esa persona conseguía una cita con el cirujano
ortopédico recomendado sólo para que le dijeran: 'Hago rodillas, pero no sé mucho
de la muñeca'".
El Dr. Badia habla de ello en su libro Healthcare from the Trenches. Todavía espera
que pronto haya voluntad política para mejorar esta situación, ya que muchos
médicos se están jubilando anticipadamente o modificando ampliamente sus
prácticas, como él mismo.