Healthcare that puts patients first | Kerry-Ann Mitchell | TEDxOhioStateUniversity
URL: https://www.youtube.com/watch?v=-d4NG8fTzSo Video ID: -d4NG8fTzSo ============================================================ [Applause] [Music] [Applause] hello everyone I'd like you to pause for a moment and take a look at your neighbor are they happy are they sad maybe a little bit excited now imagine if your face didn't communicate at what you wanted to show to the World Imagine if your facial expression wasn't a reflection of who you truly are now for some patients whether because of trauma or surgeries or cancer their facial expression may not reflect who they really are this is my patient Betty she came to see me at the neuroplastic surgery program at the Ohio State University now it's a long journey for Betty to get here and I parallel that to my journey to becoming a neuroplastic surgeon here my journey started in a small village on the island of Jamaica called jalta it's so small that on most Maps it's not even labeled but it's up on the North Coast near the town of OTAs I grew up in a very large family with six brothers and sisters in one of my Vivid childhood memories is one of my younger brothers suffering from seizures that was my first inspiration to wanting to become a physician Ian now in my town it was pretty much a pipe dream to say I want to be a physician I didn't know any Physicians and no one in my family had even been to college and so it was that after graduating high school I found myself working as a waitress in oares call it Serendipity or luck but I met a college recruiter who was vacationing in Jamaica while waitressing and she told me about opportunities to come to the United States so opportunities and growth and Innovation often take risk and so for me it was a risk to come to the United States to leave my family leave all the familiar for growth and so it was that I was able to come to the United States and attend college and go on to medical school and become a neuroplastic surgeon so too the Ohio State University had to take a risk and recognize that Innovation requires risk and invest in programs such as the neuroplastic surger program so that we can help patients like Betty so here is a photograph of Betty in the middle and you can see that she has some facial differences on the CT scan or it's a 3D reconstruction of the CT scan image on your left you can see that some of her bone is missing and this is what is causing this facial abnormality there pieces of bone that has somewhat dissolved over time what we call bone resorption this may be due to to things such as infections inadequate blood supply so Betty had had numerous life-saving surgeries to protect her brain but over time this has caused the bone to dissolve so for many years Betty lived like this this is a CAT scan or CT scan of Betty's brain and what you may be able to appreciate is that it's not in the typical round configuration that you'd expect of a brain and this is because the brain itself doesn't really have a round structure it conforms to the casing of the skull and so the skull provides that shape that helps the brain to have its normal round configuration so in BET's case because there's no bone it causes this configuration now this is not simply about Aesthetics or the appearance it also has functional implications here's a video of Betty in from one of her clinic visits with me just end up going back to sleep again Betty can you open your eyes for me hey you need you to open your eyes okay can you tell me your full name okay so what you may be able to appreciate is that she has significant neurological deficits Her speech is impacted her mental status is impacted her balance is also impaired and so she's not really able to walk and navigate stairs so she most frequently gets around in a wheelchair so for patients like Betty this is not abnormal they have very complex care needs Betty is a typical neurot trauma patient who is needs to see a neurosurgeon they may need to see plastic surgery Radiology advanced practice providers nutritionists social workers neurologists therapists infectious disease doctors and on and on and on this is a very complex care system that the patients often have to navigate these providers may be located in different locations maybe even different cities different states appointments on different days of the week Imagine the burden for the patient as well as for their caregivers to have to navigate these complex Care Systems it's very disjointed and fragmented is this a system of Health what is health anyway in 1949 over 70 years ago the World Health Organization defined Health as a total state of physical mental and social well-being and not merely the absence of disease now imagine Betty is able to come to the neuroplastic surger program at the Ohio State University she's able to see all the people she needs to see in behind the scenes we take on the burden of coordinating the care for the patient is this a better system of health so Betty comes to see us and we perform her surgery we remove the pieces of bone that were dissolved and we create create custom implants to recreate the configuration of her skull now these implants aren't designed to just protect the brain and recreate the skull we also systematically design these implants so that the patient's aesthetic appearance is restored their normal facial expressions is restored as best as possible so on the image on your left you're able to see the implants that we created and we secur it in place with hardware and then on your right you can see over time that his brain has expanded back to that round typical configuration of the brain and it now fits that encasement that we have provided with these implants again this is not simply Aesthetics there are also functional implications so I'd like to show you a video this is 3 weeks after her surgery Betty came to see us in clinic come Betty oh my gosh you look amazing can you tell me your full name Betty Jame Richards wow how old are you 22 okay and where are you right now you're 24 2 so you can see she's still so you can see she still has some neurological deficits but undeniably she's dramatically improved Her speech has improved her mental status has improved her ability to walk her balance has improved after some Rehabilitation and she's not only able to walk in the hallways of the clinic but she's also able to navigate the stairs at her home and is at this point that we can say Betty has a condition called syndrome of the trind which interestingly we diagnose it after the patient improves it's due to piece of the skull being missing and when you replace that whether the skull is replaced or an implant to replace the skull the brain expands through its normal configuration and the patient improves so it took a while for Betty to get here over 10 years and for us to think about what prevented her from seeing us earlier right was it necessarily her bone was resorbing and dissolving and her facial features were changing and her parents were changing family saw this clinicians saw this she wasn't really referred so then let's take a look at why was she referred over time the resorb bone finally poked through her scalp and created a small wound and this wound was immediately recognized as a medical necessity that this is not cosmetic it's a wound so on one hand we have these dramatic changes happening with her brain and her skull but it was not recognized as a medical necessity and so she was referred for the wound so one of the big barriers here is the knowledge deficits patients often don't know what care is available and clinicians may not know that patients can improve with care appropriate care access to care patients from rural areas or far away towns may not be near large centers such as the Ohio state where they're able to easily access care imagine if we had a fragmented care system how much more challenging that would be for the patient finally insurance coverage how are they going to afford to pay for this care if we say this is a cosmetic problem or an aesthetic deformity it is not covered by Insurance it has to be clearly defined as a medical necessity for insurance to pay for the patient's care so how are we as clinicians doing with clearly documenting that these aesthetic issues may have functional implications well we surveyed all the databases or we looked at all the databases and we found over 2,000 articles that are looking at patient outcomes after cranioplastic surgery and what we found was that at these 2,000 articles only two addressed aesthetic complications two of 2,000 addressed aesthetic complications after cranioplasties we can do better medicine has advanced tremendously over the last century even over the last decade and we have created enormous novel innovations that were able to provide life-saving care for our patients now the charge for us is to move Beyond surviving to where we're moving beyond the diseases and caring for our patients and putting the patient into Focus let's move Beyond here we can take a look at Betty I'll have you pause for a moment that is when she first came to our Clinic here she is immediately after our surgery and then here she is 2 years later what does her face communicate to us when we can do better and advance and grow with Innovation and the Technologies available to us we can move beyond the diseases and start focusing on what the patient's outcomes are let's move Beyond trauma disease Strokes cancer surviving let's focus on living and thriving let's focus on improved quality of life and helping everyone live their lives to the fullest thank you [Applause]