Q&A with Dr. Richard Schwend: Safety, Surgery, and Relationship Building

Richard Schwend, MD, FAAP, Orthopaedic Surgery, was recently in India representing the Pediatric Orthopaedic Society of North America (POSNA) to give the keynote speech at the Pediatric Orthopaedic Society of India (POSI) Annual Conference.

While he was there, he was also a visiting professor at Ganga Hospital in Coimbatore, India where he was able to perform live surgery. We spoke with Dr. Schwend about surgical safety, building relationships, and his experience as a surgeon in another country.

Why did you choose the topic of surgical safety for your oration?

Dr. Schwend: We say, “Safety Always.” Surgical complications such as death, paralysis, infection, failed surgery, revision surgery, bleeding, transfusion, can be devastating for a child and family and are costly.

This is a huge topic in this country, and it’s important because it hasn’t taken off internationally as fast as it has here.

In 1999 the Institute of Medicine published To Err is Human: Building a Safer Health System, highlighting the number deaths that occur each year from avoidable medical complications. Something needed to be done and the report emphasized a system approach to patient safety. Everybody kind of relates it to the airlines industry. Airplanes used to be less safe than they are now, so the airlines started developing safety mechanisms and checklists.

So, the World Health Organization developed a surgical checklist to make sure you have the right patient, the right extremity marked, you know what anesthesia you’re going to deliver, and certain things you just check off before the surgery.

Doesn’t that already exist?

Dr. Schwend: It does, but it was never standardized. They try to promote this all throughout the world, but not everyone does safety checks. So, it’s still compared to the airline industry that we haven’t caught up to where they are at. And their safety record is pretty good - much better than medicine.

The purpose of my talk was to try and get them enthused about safety. Preventing problems and when you do have a problem, such a near miss, investigating it properly.

The audience was a lot of doctors early in their practice, so I was hoping to reach the younger generation. For the surgeon to have a major complication is most difficult for everyone involved, especially if the surgeon is young in their career.

Before your trip, you obtained a temporary medical license to use while In India. What was your experience like performing surgery there?

Dr. Schwend: I did two live surgeries – a Ganz periacetabular osteotomy for hip dysplasia for an 11-year-old girl and a posterior spine fusion and instrumentation for a 13-year-old girl with adolescent scoliosis. They had very good doctors assist me.

Ganga hospital is really well-known for delivering high quality, live surgery. They had an audience of 500 people. They are masters at photographing surgeries. They have an audio-visual staff of 60 people. They did 20 live surgeries in two days. It’s incredible.

It’s such a quality level. They had a microphone on me, they had an overhead camera, they had a camera come in from the side. I’d never had that experience before.

What else was interesting about Ganga Hospital?

Dr. Schwend: It impressed me that the mission of that hospital was to not deny anybody any care at all. If somebody couldn’t pay for their care, it didn’t matter, they did not turn people away.

One of the hospitals co-directors, Dr. Rajasekaran, he’s the world premier spine surgeon for tuberculosis. He’s really well-known internationally. People all over India with spine deformity from tuberculosis will come and he’ll take care of them and it doesn’t matter if they have funding or not. They get good quality medical care for free, if they cannot pay for it.

How are experiences like this beneficial to providers and hospitals?

Dr. Schwend: This is how these relationships are built. You go and you visit, and you invite people and then their people want to come visit us, and you develop an international program.

Dr. Sabapathy, the hospital’s other director who is very well-known for microvascular surgery, is coming here next fall as a visiting professor.

A doctor that was in attendance for my oration came up to talk to me and he’s now coming to visit this spring. He’ll come and observe what we do and ask lots of good questions. It will be good to have my practice looked at. And it’s good for our residents to be exposed to somebody from another culture.

I think these things are really important. You never know what kind of good things are going to come from them.