“Robotic Surgery is the Most Sophisticated”
Dear Mr. Kočárek, I will begin by congratulations. The Military University Hospital has been ranked the best hospital in the Czech Republic according to the project conducted by the Health Care Institute. The aim of the project was to establish ranking of Czech hospitals according to safety, and satisfaction of both employees and patients. In order to do so, a Balanced Scorecard approach, known in many commercial organizations, was used. From the above said, you need to have not only the highest medical qualification, but also the management one. How do you balance both? What capacity do you dedicate to patients, to students and to running the department?
I was really pleased to get the award. I am really happy to see that patients of the Military University Hospital appreciate our work. However, it is rather a big commitment for the future. Today, we are already facing the challenge of too many new patients coming in, since everyone “wants” to have own surgery being done at the best hospital. Every day, we need to fight the challenge concerning our capacity to accept patients to a ward, the number of people we are able to perform a surgery on given the capacity of central surgery theatres and then the availability of hospital beds. Within the context of the situation, we are continuously suffering the lack of nursing staff. During the last six months, on monthly basis, we have repeatedly had to address the issue whether we’d have enough nurses to secure running of the department for the upcoming month. I do not want to complain but it would be great to have the opportunity to offer some extra benefits to the staff in “the best hospital”, so we would have more time to dedicate to medical issues. On the other hand, I do not find challenging to be able to balance managing the department, caring for patients and teaching students, as I enjoy doing it all and to a certain extent I do not consider it work in the proper sense of the word. Teaching and passing own my own experience to younger colleagues is rather a nice duty. There is one thing that comes to mind and that is gender imbalance. That is a real problem. If you ask me how much time I spend at work, I will not answer directly, as my wife could come across the article. However, she got used to the fact that during the weekdays, my family does not get to see me much. I try to devote weekends to my family and so I start working only after my children fall asleep.
Lately, there is a hot topic related to young Czech medical doctors leaving for abroad. You had the opportunity of internships in the US, France and Germany. Have you personally considered leaving the country? And leaving aside remuneration, are the conditions similar when you compare current situation in hospitals in the Czech Republic and abroad?
I consider not only young doctors but also other personnel leaving for abroad due to financial conditions a big problem. Lack of qualified Czech doctors makes us employ doctors coming from countries East of the Czech Republic who are willing to work for “the Czech salary”. I believe that every doctor should have the opportunity to take part in several internships abroad. I was particularly lucky to have the opportunity to visit some outstanding urological departments both in Europe and in the US. In a certain way, I still benefit from these stays, regarding not only practical experience but also personal contacts. I would not say that I have not considered leaving for abroad, but particularly after 1989, such thinking was less frequent. And as to the question of comparing the Czech medicine, I cannot compare the total discipline as such. However, Czech urology and Czech robotics surgery are comparable to the best departments in the West.
There is one more primacy for the Military University Hospital in Prague. As the first hospital in the region, it was awarded the Joint Commission International accreditation which is awarded for the highest quality of hospital care. What are the additional requirements for the doctors and medical staff?
This accreditation brought current US standards that are connected not only to the medical care. Overall, it resulted in higher safety for patients to the detriment of higher financial costs and an enormous growth in bureaucracy.
Your hospital is also known for the use of robots. How do you see the future of medicine from the robotics perspective?
I have been interested in robotic surgery since 2005. Since then, the robotics technology has developed and today we are equipped already with the fourth generation of robotic systems. Robotic surgery is nowadays the most sophisticated technology used in the surgery medicine. Twelve years ago, we walked over the doorstep leading to a new era characterized by artificial intelligence becoming an interface between a surgeon’s hand and a patient’s body, a move that was unprecedented. Despite some negative opinions in the beginning and due to the rising number of publications, robotic surgery has become an integral part not only of urology, but also surgery as such, gynaecology as well as of other disciplines. It was proven that technical advantages of robotic machines can overcome many limitations of classical and laparoscopic surgery (operative) and that they considerably advance the learning process. The undisputed benefit for both patients and those who cover the costs is represented by limiting traumatization of tissues during the surgery, lowering the possibility of complications, lowering blood loss and the need for blood transfusion, lowering after-surgery pain and discomfort, shorter hospitalization period, faster recovery and return to a normal life. In the upcoming years, we can therefore expect a fast development of new robotic centres. Such trend will be supported by the increasing interest of our patients to use robotic technologies during surgeries and also the new competing products from producers of robotic systems into any particular surgery discipline.
Now, let us discuss a more serious issue, the prostate tumour as the most frequent tumour for men’s population. How is the Czech Republic doing in the area of prevention? When I compare the situation with breast cancer for women, a lot has been achieved with regards to prevention check ups and awareness about both prevention and treatment.
The prostate carcinoma is according to the statistics the highest tumour disease in developed countries. It is a disease that has also the highest incidents of detected cases. Men usually do not like to go and have check-ups and therefore, they underestimate the need for the prostate to be checked. They feel healthy, they do not see value in the importance of prevention or they do not anything about it. Therefore, a number of Czechs having the prostate cancer will continue to rise. Despite the common claim, prostate cancer is not linked to a senior age. All men reaching the age around 40 should pay attention to preventive care. Men aged 50 and older should have a regular check-up once a year, either by a general practitioner or a specialized urologist. In order to detect the disease early, sometimes a simple blood test is sufficient, since the experts are looking for a specific antigen, which if increased, can signal the prostate cancer. It is true that early detected prostate carcinoma can be cured completely with the use of robotic technology.
Let me mention one sadder Czech primacy in the world, this one concerning kidney tumour. What is your recommendation?
There are more than 3000 new incidents of kidney tumours detected each year which per capita truly places us at the sad first place in the world. Thanks to a wide-spread network of ultrasound and CT devices, more than a half of these diagnosed cases are at the early stage where we can perform a resection of a tumour and keep the healthy part of the kidney. Leaving the maximum functional kidney parenchyma has a big importance for patient’s health and favourably influences the active life span. Naturally, robotic technology is very much helping us in these types of surgeries. In general, we can claim that in the early stage kidney cancer does not pose any complications. As the tumour grows, there can be an incidence of blood in the urine. This is the most frequent symptom that brings a patient to see his doctor. Sometimes, the bleeding occurs without any other symptoms. It is important to state that each time, the incidence of blood in urine should be checked. The next common syndrome is the pain in the lumbar area or sometimes a palpable tumour. Anyone having a symptom mentioned above should see his general practitioner or a urologists. The early detection of a tumour gives us a higher probability for complete recovery.
Medical doctors are being regarded role-models for their patients. Have you made any special resolution for 2017? And what is your recommendation concerning healthy lifestyle and work-life balance?
I would like to mention my resolution with regards to shortening my “stays” in hospital, spend more weekends with my family and going to the mountains more often. This winter has been very conducive to do so; my five-year old son has begun to chase his older sisters at the slopes. For the sake of children, but not only for them, I am very happy that smoking in public places will be finally completely banned. Every day, I see patients diagnosed with urine bladder carcinoma and most of them have admitted either active or passive smoking. I generally recommend active relaxation, moderation when it comes to food but plenty of fluids. When it comes to alcohol, I recommend to drink in moderation, which is unfortunately lacking sometimes.
By Linda Štucbartová