Last Week in Porto

My last week in Porto...

1. Monday: Dinner with the Bastos
Dr. Basto and his family invited me and the residents and attendings that I worked with to their home for dinner. It was a lot of fun! We had bacalhau com nata, and of course some very good Port with desert.

2. Tuesday: Matosinhos
On Tuesday, I met with Dr. Pinheiro from the Unidade Local de Saude de Matosinhos. Matasinhos is a neighboring town to Porto, and there Dr. Pinheiro showed me his vision of how the public health system should function. It is a completely integrated system with a hospital, primary care centers, diagnostic centers, and continuing care centers. Most of the integration is achieved by a very sophisticated computer system. Patient information, etc can all be accessed at all of the associated centers, that way there is better continuity and efficiency of care for the patients.
The primary care centers approach to the patient is very holistic one, and it involves the entire family. They really work hard to take care of the patients and keep them out of the emergency room and hospital. The center that I visited was very nice. All of the facilities were state of the art. It is organized such that each physician (Family practice physician) is paired with a nurse, and each physician-nurse team is responsible for 2000 patients. The set up seems very efficient. The computer system has particular programs that monitor hypertension, diabetics, CAD, etc. For example, a diabetic patient has a flow sheet and tracks their glucose levels, A1C, blood pressure, weight, cholesterol, etc. It is all organized in such a way that it is not only very easy to keep track of all of the information, but also this information can be shown to the patient in a chart format which is very easy for them to understand.
The hospital is a community hospital and therefore is quite smaller than HSJ. It is however only 10 years old and resembles any typical hospital one would find in the US. It serves as a referral center, that way if there is something that cannot be managed by the family physician, the patient can then be referred for further workup or to see a specialist.
Also very important to the system is the continuing care center. This center also works as a way to keep patients out of the hospital. As is it is not a hospital, there is more patient to patient interactions, and patients are also encouraged to spend time in common areas outside of their rooms. This center provides specialized care to patients that have suffered stroke, or any other debilitating illness that may require intense rehabilitation. With more intensive care, patients can return to their homes faster and with better results. The center is also for those patients who are receiving palliative care and cannot be managed at home.
Overall, Dr. Pinheiro has made me a believer in this system. I hope that a model similar to this can be implemented for our future national healthcare system.

3. Visit to InstitutoCUP
Instituto CUP is a private facility with primary care consultations, imaging, dermatology, GI, oncology, radiation oncology, ophthalmology, rehab, and day surgery. It is only 2 years old, so it is very new and it is very state of the art. They have almost everything you can imagine: an MRI, 2 CTs, equipment for lasix, a lab, a cafe, and even a nuclear accelerator. The director, who gave me a tour of the facilities, stressed that it is not a hospital, although with all of the services they provide, one may think just that.
The patients seen here are patients who have private insurance, however the national health system can also send patients to receive services here when those services are not available in the public system. But for the most part, this center is for patients with private insurance.

The biggest difference that I noticed between the public and private clinics where not the quality of the facilities, as both facilities where quite new and very well equipped, but more so the attitude of the healthcare workers about the patients. Of course, both clinics treat their patients very well and do what is best for them. But the public clinic's attitude was more of "we are all in this together". In the hospital, the physicians and healthcare staff eat the same food as the patients, and patients and physicians cross paths quite frequently, whether it is in the hallway, elevator, or lobby. However, in the private clinic, the director stressed repeatedly the fact that the patients and physicians are always separated. There are separate entrances, hallways, elevators, eating facilities, etc. EVERYTHING is always separate. The patients and physicians only cross paths during the consultations.
I don't think one approach is better than the other, just different. I guess what I'm used to is the environment at UNC where we all use the same elevators, the same cafes, hallways, etc. For this reason the environment at the private clinic seemed strange and a bit cold.

Overall, it was a busy week, but also the most interesting. On Thursday, as the rain stopped for a couple of hours, I also had the chance to go back to the coast :)