By : Elias Forero Illera
Internista reumatólogo. Rheumatologist internist. Internista reumatologista

09 April, 2022

"“A certain intellectual mindset, an academic culture, a strong focus on patient outcomes and an inspiring environment for young talent are the ingredients of a world-class hospital that endures for decades.” World’s Best Hospitals"

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Elias Forero Illera


Newsweek recently published the ranking of the 250 best hospitals in the world. Few news items arouse as much interest as knowing the ranking of something. As soon as I saw the magazine's headline, I opened its website. I asked myself many questions as I enthusiastically read the article. Which were the best? Which would be the best in Spanish? What were the criteria for choosing them?

The best, the Mayo Clinic in Rochester; Hospital Universitario La Paz the best in Spanish. The criteria for the choice were summed up in a couple of sentences: “What has distinguished the world's leading hospitals is their ongoing ability to provide the highest quality patient care and conduct critical medical research even while focused on fighting COVID.”

A certain intellectual mindset, an academic culture, a strong focus on patient outcomes, and an inspiring environment for young talent are the ingredients of a top-tier hospital that endures for decades.”

This last sentence reminded me of a note written to my daughter who was starting her first semesters in medical school and that I want to bring back today thanks to the Newsweek article.

I entered the San Juan de Dios Hospital in Bogota with expectations only comparable to those of a child entering Walt Disney World. At San Juan, the best medicine I have ever seen in my entire professional practice was being practiced. The above statement is not based on the fact that this hospital had the best technology or the best infrastructure. No, there was only what was necessary. 

What was left over, on the other hand, was mystique, the desire to care for people, to find diagnoses, to save lives regardless of social status or wealth. 

At San Juan we did not ask about policies, insurance or who was responsible for the invoice, people were cared for and that was it. 

This text was read by my daughter Laura, who, somewhat incredulous, asked if what I wrote was true. She thought it was just another trap, set by nostalgia, into which those who write about the past without having a contradictor fall into. 

Of course it's true,” I answered immediately. “I will tell you the case of a man who arrived one night at the San Juan emergency room,” I added. 

He was young and was admitted late at night with severe pain in his right side. He went immediately to the internal medicine office where I was on duty. After taking a medical history, I concluded that it was an inflammatory lesion involving the pleura and that it had to be studied. I ordered lab tests, a chest x-ray and an analgesic. I was distracted attending to the countless patients when I was advised that the patient’s pain was increasing considerably and the analgesic ordered did not seem to be sufficient therapy to alleviate the pain. Other measures had to be taken.

I decided not to wait for the orderly, sat him in a wheelchair and headed to the radiology room of the emergency department. The labs were in process and the x-ray was missing. The X-ray technician, also busy, instructed me to leave the patient by the door; he would pass him at the first opportunity. At San Juan there was plenty of work, so I busied myself seeing other patients while the film was being taken. 

The technician arrived minutes later with the film in hand. From the intense pain we expected a large lesion, but the image didn’t say much. A small opacity at the right base was seen on the X-ray, period, the rest normal. The radiology resident, alerted by the technician, came to lend a hand with the case. We decided to do an ultrasound. The echo showed a collection, of low volume, in the area of the opacity seen on the x-ray. That was the problem. We needed higher resolution equipment so we sat our patient in his wheelchair and went up to the radiology department. 

The pain was now accompanied by chills, the patient felt worse. The higher resolution equipment showed the low volume collection, clearly coincident with the site of the pain. Using a syringe I easily punctured the area under ultrasound vision. A green, thick, foul-smelling fluid drained without difficulty. I obtained about 10 cc; the screen showed no collections. When the needle was withdrawn the pain diminished noticeably, the man felt better. We returned to the emergency room, he was to be evaluated by the surgeons.

When surgeons assessed the patient, his pain and chills had disappeared. Because the collection was completely drained, they decided to continue treatment with antibiotics without placing a chest tube. At dawn, the patient was hospitalized on an emergency stretcher, pain-free and fever-free. Seven days later he was discharged with full recovery and no tubes. 

All of the above was done overnight, in a few hours, without asking for orders, authorizations, fees, nothing. An unreal world in light of the administrative and financial concepts that govern healthcare today.

It makes me sad to know that Laura, now a medical student, will not be able to live those magical moments, utopian if you will, that I experienced at San Juan de Dios. The hospital was closed thanks to the ineffectiveness of governments and leaders.

Today, after reading the ranking of hospitals, I remembered this note written in homage to the hospital where I received my training and also, I relive the hope that Laura and now Miguel, my children, doctors in training, will find a place in a hospital where the mystique of the closed San Juan still exists.




1.  World´s Best Hospitals Disponible


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