Innovation in our lifetime: The changing face of medicine
Posted on 11 April 2019
With constant advances, the face of medicine has changed radically in the last few decades. Three Mediclinic Panorama doctors in their 60s reflect on the innovations they’ve seen in their respective fields.
DR HANS RABE (68) UROLOGIST
Dr Rabe began practising as a urologist in 1982. “I was here on the first day Mediclinic Panorama opened in 1986,” he recalls.
“Since I started here, the biggest change has been the move towards less invasive surgery, and the resultant shorter hospital stay for patients,” says Dr Rabe, reflecting on technological improvements. Stone surgery, especially, has become totally non-invasive because of endourology, or “urology from the inside”.
Mediclinic Panorama has become a tertiary referral centre, drawing patients from all over SA and neighbouring countries for specialised procedures, such as brachytherapy for prostate cancer, laparoscopic kidney surgery and paediatric urology. “We have two trained urologists who currently perform robotic surgery at hospitals nearby.”
Urology practices have become much more regulated, he adds. “It means there’s more control, with more paperwork and correspondence. You need a full-time person to do just that, but it’s a good thing. The fully electronic way of billing and business processes has revolutionised private urology.”
The turnover in patients has increased for all doctors, especially those that have invested in their own technical aids – like ultrasound and flexible cystoscopy in the urologist’s own rooms. “Many more things can be done, which saves time, money and offers more convenience for patients.”
▶ FACILITATING GROWTH
Dr Rabe has been directly involved in modernising his field. He introduced the idea of each urologist having their own ultrasound machine. The practice of urology is now unthinkable without this aid.
He, together with a Mediclinic Panorama oncologist, also pioneered brachytherapy for the treatment of prostate cancer in SA in 1997. “There are now 64 units in the country, but the first thousand or so cases were done in this hospital,” he says. “With brachytherapy we put radioactive seeds into the prostate, which kill the cancer from the inside. It’s more effective than any type of prostate removal operation. It’s basically an outpatient procedure and the side effects are minimal. With brachytherapy, all patients retain control of their urine and 90% retain their potency. This is particularly attractive for younger patients.”
▶ THE FUTURE OF UROLOGY
Dr Rabe believes sub-specialisation will define the future of his field. Doctors striving to establish themselves in metropolitan areas should spend some post-specialisation time with this in mind. “Mediclinic Panorama’s status as a tertiary referral centre is attributable to the quality of its specialists and a reputation for excellent patient care.
We have a spread of specialists covering every aspect of medicine, and this quick in-house referral setup has become a well-known entity in the public mind. We strive to build on this solid foundation for the future.”
Dr Rabe plans to work till he’s 75. “My practice is still growing, so why stop doing what I love and find fulfilling?”
DR LEON VENTER (67) GYNAECOLOGIST AND OBSTETRICIAN
Initially a GP, Dr Venter began practising as an obstetrician in 1992 and later joined Mediclinic Panorama. During his time in the field there have been numerous developments.
▶ POSITIVE DEVELOPMENTS
The means through which pregnancies were monitored used to be a lot less sophisticated, says Dr Venter. “Cases like interuterine growth retardation were monitored doing serial hormone levels – a crude way of monitoring foetal well-being. Subsequently it’s become much more sophisticated with the advent of the Doppler scan.”
In pregnancy, this is used to study blood circulation between the baby, uterus and placenta. “The Doppler went through various stages of development and is currently quite effective in monitoring situations like foetal growth retardation, although it does have limitations.”
“Improvements in neonatal care have impacted very positively on the outcome of pregnancies and neonatal survival,” continues Dr Venter. “This is through the advent of drugs that improve the maturity of the lungs and all kinds of technology that can improve the survival of the foetus.”
“The advent of the endoscopy in the gynaecological field was a major step forward,” he adds. “Still developing, it’s the future of gynaecology. In the olden days we used laparoscopy just for sterilisation – now all kinds of gynaecological operations can be done with endoscopy.”
▶ OBSTETRIC CHALLENGES
Yet changes have not all been positive, says Dr Venter. “It’s incredible how litigious the whole scenario has become. I think that’s one of the reasons why the C-section rate has increased so much – some doctors opt for the safer option because of the fear of litigation.” There are also the costs of insurance against litigation to consider, he adds.
For that reason, Dr Venter believes that obstetrics in the future will be more in line with the British or Canadian system. “In my opinion, obstetrics should be done with a midwife and overseen by an obstetrician – it’s becoming expensive for people to afford private obstetrics.”
DR ADRI VAN DER WALT (68) NEUROPAEDIATRICIAN
Beginning her practice as a paediatrician before Mediclinic Panorama was built, Dr Van Der Walt has been at the hospital since its inception. She has practised exclusively in paediatric neurology and development since 2005.
“Developments in paediatrics both in neurology and development, have given doctors the ability to make earlier diagnoses,” she says. “We can also make more specific diagnoses especially around certain developmental issues.”
▶ IMPROVED IMAGES, IMPROVED TREATMENT
“Our ability to image has improved so much with the MRI and its improved quality,” she says discussing developments in her field. “Because I’ve been doing paediatrics for such a long time, I started without even being able to do a CT scan. We thought those were fantastic when they started. Then the MRI came about, which made a massive difference in our management and understanding.”
“I started paediatrics when medication was very restricted and that’s developed dramatically,” she adds. “It’s made it easier to manage patients with less side effects.”
Dr Van Der Walt is also fascinated by the increased knowledge around different diseases and their causes. She feels that the future of her field lies in genetics. “Our ability to use genetics as a system whereby we can clarify the clinical pictures will define the future and allow us to give parents a better understanding of why things are happening.”
WORDS: GILLIAN KLAWANSKY