Healthcare that puts patients first | Kerry-Ann Mitchell | TEDxOhioStateUniversity
The speaker, a neuroplastic surgeon, argues that advancing medical care requires shifting focus from simply treating disease to enhancing the patient's quality of life, citing Betty's case where skull reconstruction led to functional improvements, including a condition called syndrome of the trind. Betty's journey from bone resorption and significant neurological deficits to functional improvement was initially overlooked because the issue was deemed aesthetic rather than a medical necessity. This necessitates addressing knowledge deficits in both patients and clinicians regarding necessary care.
## Speakers & Context
- Speaker: A neuroplastic surgeon.
- Patient Example: Betty, who came to the neuroplastic surgery program at the Ohio State University.
- Speaker's Journey: Started in Jalta, Jamaica, growing up in a large family; first inspiration to become a physician was witnessing a younger brother's seizures.
- Personal Risk-Taking: Worked as a waitress in Jamaica before a college recruiter informed her of opportunities in the U.S., which she took despite leaving family and familiar surroundings for growth.
- Institutional Support: Ohio State University took a risk by investing in the neuroplastic surgery program.
## Theses & Positions
- Innovation and growth require risk.
- Medical treatment must move "Beyond surviving" to focusing on "living and thriving" and improving quality of life.
- A functional aesthetic restoration, achieved through surgery and implants, can lead to measurable neurological and physical improvements.
- The healthcare system must move beyond a fragmented model of care to one where specialized providers coordinate for the patient.
- Restoration of form (like the skull) can be fundamentally linked to functional neurological improvement.
## Concepts & Definitions
- **Neuroplastic Surgery:** The field the speaker practices, involving procedures to help patients whose facial expressions or structure do not reflect who they truly are due to trauma, surgery, or cancer.
- **Bone Resorption:** The process where bone dissolves over time, potentially due to infections or inadequate blood supply, leading to facial abnormalities.
- **Syndrome of the Trind:** A condition diagnosed *after* a patient improves following skull reconstruction, due to the brain expanding into the newly available space.
- **Medical Necessity:** The designation required for insurance coverage; a condition must be clearly documented as medically necessary, not just cosmetic.
## Mechanisms & Processes
- **Complex Care System Navigation:** Patients like Betty require navigation through numerous specialists (neurosurgeon, plastic surgeon, etc.) across different locations and providers.
- **Surgical Restoration:** Involves removing dissolved bone pieces and creating custom implants to:
1. Protect the brain.
2. Recreate the skull's configuration.
3. Restore aesthetic appearance and normal facial expressions.
- **Functional Improvement Mechanism:** The implants recreate the encasement, allowing the brain to expand back to its "round typical configuration," which enables physical recovery.
- **Referral Barrier:** Betty was initially referred only because the resorbed bone created a small, visible wound, which was recognized as a medical necessity, not just an aesthetic issue.
## Named Entities
- **Jamaica:** Island where the speaker grew up.
- **Jalta:** A small village on the North Coast of Jamaica, where the speaker grew up.
- **Ohio State University:** Location of the neuroplastic surgery program where the speaker practices.
- **Betty:** Patient example showing facial differences due to bone resorption.
- **Betty Jame Richards:** Betty's full name.
## Numbers & Data
- Number of siblings: **Six** brothers and sisters.
- Date of WHO definition of Health: **1949** (over 70 years ago).
- Total articles surveyed on patient outcomes after cranioplastic surgery: **over 2,000**.
- Articles addressing aesthetic complications among those surveyed: **only two of 2,000**.
- Years for Betty's full process: **over 10 years**.
## Examples & Cases
- **Betty's initial state:** Facial abnormalities due to dissolved bone; CT scan showing lack of bone structure.
- **Betty's deficits (initial):** Significant neurological deficits, impacted speech, impacted mental status, impaired balance, necessitating a wheelchair.
- **Betty's functional improvement:** After rehabilitation and surgery, she was able to walk in clinic hallways and navigate stairs at home.
- **The Obstacle:** Initial lack of recognition that the aesthetic issue was a medical necessity, resulting in delayed care.
- **Systemic Deficiency Example:** The difficulty of navigating fragmented care involving multiple locations and specialists.
## Tools, Tech & Products
- **CT Scan/3D Reconstruction:** Used to visualize missing bone structure and the brain's actual configuration.
- **Custom Implants:** Devices created during surgery to recreate the skull's configuration.
- **Hardware:** Material used to secure the custom implants in place.
- **Wheelchair:** Mode of transport for Betty due to balance impairment.
## References Cited
- **World Health Organization (WHO):** Defined health in 1949 as a "total state of physical mental and social well-being and not merely the absence of disease."
## Trade-offs & Alternatives
- **Care System Trade-off:** Fragmented, disjointed care vs. centralized coordination (like the program at OSU).
- **Payment Barrier:** Insurance only covers care deemed a "medical necessity," creating a barrier for aesthetic/developmental issues.
- **Focus Shift:** Surviving (treating disease) vs. Thriving (improving quality of life).
## Counterarguments & Caveats
- **Initial Perception:** The issue was initially seen as purely "aesthetic" or "cosmetic," which blocked necessary medical intervention and insurance coverage.
- **Knowledge Deficit:** A major barrier exists where patients and clinicians do not know what appropriate, available care exists.
## Methodology
- **Clinical Case Study:** Using Betty's recovery trajectory as the central illustration of success.
- **Database Review:** Surveying **over 2,000** articles to quantify the systemic failure to address aesthetic complications after cranioplasty.
## Conclusions & Recommendations
- The medical focus must move "Beyond diseases... to focus on living and thriving."
- The goal is to improve quality of life, not just to treat symptoms.
- Systemic change is required to ensure that aesthetic/structural issues are recognized as medical necessities deserving of care.
## Implications & Consequences
- Proper structural support (implants) allows the brain to achieve its normal, round configuration, which functionally enables rehabilitation (e.g., walking, speaking).
- Ignoring the "why" (the underlying function) of a condition, focusing only on the "what" (the visible problem), leads to gaps in care and poor outcomes.
## Verbatim Moments
- *"Imagine if your face didn't communicate at what you wanted to show to the World."*
- *"I parallel that to my journey to becoming a neuroplastic surgeon."*
- *"Opportunity and growth often take risk."*
- *"This is a very complex care system that the patients often have to navigate."*
- *"is a total state of physical mental and social well-being and not merely the absence of disease."*
- *"we take on the burden of coordinating the care for the patient."*
- *"we systematically design these implants so that the patient's aesthetic appearance is restored their normal facial expressions is restored as best as possible."*
- *"we can do better medicine has advanced tremendously over the last century"*
- *"let's move Beyond the diseases and caring for our patients and putting the patient into Focus"*
- *"let's focus on living and thriving"*