Hospital medicine in South America

A hospitalist-in-training reports from PASHA, the first congress of the Pan-American Society of Hospitalists, held in November in Brazil.

Embryonic. Hospital medicine in South America is still embryonic. An embryo in its first stages of development, but with enormous growth potential. That is the impression I took home from PASHA, the first congress of the Pan-American Society of Hospitalists.

The meeting, held in November at a beautiful beach resort in Florianópolis in southern Brazil, was pioneering in several aspects. It had no pharmaceutical industry support whatsoever, making it one of the largest medical conferences without pharma money ever held in Brazil. In a country where lack of funding is the rule, industry's support is often deemed necessary for events like this to happen. An icon of the absence of industry's money was the literal coffee break: free black coffee during the break. That's it—no cookies, no fancy ice cream, no mochaccinos. Talking to other attendees and my medical school colleagues I found mixed reactions. Some approved of the idea, others just wanted a cookie.

Photo courtesy of Ricardo Parolin Schnekenberg
Photo courtesy of Ricardo Parolin Schnekenberg.

PASHA attracted the first few small hospitalist groups that are slowly emerging in scattered parts of South America. These groups shared their experiences, achievements and setbacks. Attendees were able to hear about a handful of Brazilian hospitalist groups that are starting to show positive results from their initial experiences. One reported a remarkable (albeit not yet statistically significant) reduction in its length of stay and readmission rate, with incredible estimated cost reductions for a public hospital.

Chile, in contrast, is much more mature in the field of hospital medicine, already integrating teaching and research into its program and showing promising results. A group of hospitalists from Santiago, Chile presented their protocols and research on prompt removal of Foley catheters, prompt management of hypoglycemic episodes, adequate institution of deep vein thrombosis and gastric stress ulcer prophylaxis, unfractionated heparin infusion charts, and strategies for establishing and boosting demand for an elective course for medical students on hospital medicine. Their presentation exhibited how hospital medicine can be implemented in Latin American hospitals with proven benefits for patients and staff. For this, they received a clinical practice award.

There were also two different groups from Argentina who showed deep interest in the idea of hospital medicine, but did not yet have hospitalist programs up and running. Unfortunately, there was marked underrepresentation of all the different countries in South America, including the notable absence of known groups from Colombia. Improving diversification and attendance by representatives of other Latin American nations should be goals for the next PASHA.

Still, I and many others like me had the chance to watch world-renowned hospitalists from the Mayo Clinic and Emory University demonstrate what hospital medicine is all about, and how patients, hospitals, physicians and current medicine can benefit from it. It all seemed so logical I couldn't stop thinking “Why haven't we been doing this all along?”

Although my career is just starting, I have been inside Brazilian public hospitals long enough to see firsthand the adverse events and unnecessary risks patients are subjected to, and witness the absurd waste of valuable resources due to lack of adequate case management. Patients and the general public have no idea what truly goes on. It is not customary for hospitals in Brazil to gather quality data and publish—or even review—their statistics on simple parameters such as antimicrobial resistance patterns of urinary pathogens or rates of surgical infections. The first steps to promoting patient safety in Brazilian hospitals and changing the status quo ought to be acknowledging the problem, gathering high-quality data, and then publishing the results, no matter how negative they may be at first.

I believe the public health system in Latin America has much to gain from hospital medicine, and apparently the Brazilian government knows it too, as it was one of the major sponsors of this year's PASHA. This congress drew the attention of mainstream Brazilian media in the form of a news article entitled “The hospitalists are coming,” published in Folha de São Paulo, the largest newspaper by daily circulation in Brazil. The author of this story, journalist Cláudia Collucci, attended PASHA and gave a talk on health care journalism and the drug industry's influence. Media coverage like this is extremely important as the lay public and even the majority of physicians in South America have no idea what a hospitalist is.

In South America, unlike the U.S., there are no reports on medical errors, and patients still think hospitals are healing centers devoid of risks. The first step to making hospital medicine a reality in South America is to share the knowledge and experience of centers where it has worked; in that sense, PASHA excelled and we got the message. Now it is up to us to nurture the embryo, spread the word and take our own first steps.