Ist Spezialisierung und Zentralisierung in der Medizin der falsche Weg? | Kolloquium Medicine | QS24

Are you already on Wikisana? Welcome, dear viewers, to our format colloquium today with our experts on the topic of what would be the wrong way if specialization and centralization were the wrong way. For this, I have Professor Petschner and Schubert with me and also Lothar Hirneise as cancer researchers and we will illuminate the whole thing. Stay tuned. Hello everyone, nice to have you back. Hello. Specialization, centralization. Thomas, can you say something about it? I think everyone can say a lot about it. Of course, there are advantages and disadvantages in every respect. Of course, specialization is nice when one knows everything about one thing substantially or as much as possible than everyone else and does not only practice it, but also continues to spread the knowledge and everything in the field of research. On the other hand, this is limited. If we think about it from a holistic point of view and what makes us all as humans, then of course specialization is not so much in demand, because that is of course a mini-mini part. As I once experienced, a colleague said at a conference, my specialization starts here and ends here, so HNO doctor and nothing else interests you. This is indicative of a separation between the two disciplines and I think it is nicer when you have a doctor or a healer or a therapist or whatever you want to call it, who thinks a little bit more broadly and has a holistic approach. I have one sitting here. We had a nice interview together where I really heard from you, this is the patient in front of me, he has depression. And then there are labs around it and then the cortisol is looked at and even more goes in and then the ATP and then the oxygen thematic and then we have completely lost ourselves. We are no longer human, but the human being was there with his topic and we go deeper and deeper and it gets smaller and smaller and completely away from where we started. So I think this form of specialization is a disaster. And on the other hand, if we have a generalist who no longer really knows himself in special areas, I'm not so sure if that's all now. But I would definitely say it's better for me, top down, looking at everything together, I would favor that as specialization and specialist and central. I got the idea, maybe Lothar Hirne too, to get into the discussion with the cancer topic. Namely, let's imagine an oncologist who has no idea about psychonormology, who takes the psyche out of business at all. So a classic dualist and reductionist, a machine medic. Cortisone dampens the inflammation, so it's a way to dampen these side effects in a chemotherapeutic treatment. But this oncologist doesn't know that he's producing stress hormones because he has no idea about psychonormology. If you now interview and look at many survivors like me, why did the people survive? Nobody. You won't find a single one who was metastasized, did chemotherapy, radiation, and got healthy again. But now there are these people. I shook my hand enough personally. I know that there are these people. And I know many doctors all over the world, I say, outside of university medicine. I prefer to call it alternative or non-alternative. As Christian just said correctly, my goodness, we can't just see this one little thing with such severe diseases. If I, in our center there are about 90% metastasized patients, yes. So the overall complex in a doctor, in my opinion, has been going in the wrong direction in the last 20 years due to specialization. Yes, as you both have already said, we need specialists. Professor König, for example, where he is at the moment, also gave an interview and I talked to her about mitochondria. And God, it's phenomenal when you have such a specialist who answers every question in the smallest detail. Yes, but to be honest, can you help someone who is seriously ill with cancer? No, but if you can get this part into an overall picture, then you can help a person. But unfortunately, medicine is too specialized in my opinion. That's the nice thing about you, with the face diagnostics, that you look at the person and you see the whole thing. That would be a small fraction of it. In holistic terms, it is not only that you include the elements of traditional diagnostics, but they are an additional part of a classic medical diagnosis. What are the elements that make us? What makes us human as we are? It's not just a bunch of bones and meat on a pile, but much, much more. And theology is also part of it for me. Sociology is part of the diagnosis. There are people who actually only need a hug to feel better. There are people who have not heard a nice word for a long, long time. You can also use the words as homeopathic remedies because they help a lot. But hardly a specialist comes to mind. You also notice in medical studies that you actually get this narrow path along the way, don't you? The medical study is represented by reductionism in medicine. And when I say reductionism, then medicine is structured in this way and in principle we are structured in society in this way. It's not just a medical problem, it's a cultural problem. We have to learn to think top-down. We have to look at the big picture, the big umbrella, so to speak, and then we will understand what's going on down there. But don't look down and then think we can understand the big picture. That doesn't work. Exactly. And also the question, do I have to understand this at all down there? If I am able to regulate this up there, then everything down there does the same. That wouldn't help. If he's traumatized, he doesn't have cortisol. That would be the other story, right. So cortisol won't tell us if someone is stressed, because we really have different cortisol developments. With traumatized people, there is no cortisol, with stress and with normal people. And I don't find that out at all at first, because if it's traumatic, I don't know. I don't find that out at all at first, because if it's traumatic, I don't know. But on the contrary, I will never be able to use biochemistry to find out the big picture, the psychology of the other. There was once the decade of the brain by Obama, which, I don't know, I think he called out in 2010 and put billions of dollars into research to find out how humans tick. And that's garbage. You can flush billions of dollars down the toilet, because in the end, that's reductionism and that's wrong. We will never know about non-material knowledge through the analysis of fine matter. Non-material is emergent, so we would have to go into system theory. Aristoteles has already said, the whole is more than the sum of its parts. I have already been to the 3E center with you. You basically already live with the patients. What are the most important factors for you where you say, hey, the patients really get it, they take a step forward. There is this swift ... Christian, you just used the word reductionism. If you really look at oncology, but also in general in medicine, the biggest reduction is actually the reduction on the body. On the cell. Or on the cell, on the body. But I have a completely different experience in my work over 20 years. At least in severe cancer patients, the body no longer plays such a big role. So also the physical development of cancer, as it is claimed today, that it all happens through poisoning, through some toxins, I can't confirm that at all. If I think, for example, that adrenalin is still not measured in cancer patients. How often have I talked to doctors and said, just measure it. We have been doing this for 15 years. We measure adrenalin in every patient. Sorry to interrupt you, but then you also look at the smallest part. Doesn't it make sense to dissolve the adrenaline-releasing psychological effect in the environment? I just have to say something about that. We don't care about the value. We don't make the value, what do I know, we make the value for a rather psychological reason. If the patients see the value. Just as an example, we Swabians, we have the problem that we don't even recognize stress. You also talk to people who say, actually I have a very nice life, I don't have any stress. And then all of a sudden we do an adrenaline test and he sees his value below 1, which is below 10 percent, what should actually be there. And he says, if I think about it like that now. And then all of a sudden it pours out of him what pisses him off in the world. And we actually with his marriage, with his job, with his spiritual life, with his sexuality, with whatever. It's actually a little bit of peace of mind, as the Swabians would say. And that's what we do it for. Of course, I am also interested in the documentation or something like that, because I love something like that. But otherwise, no, that's not the case for the patient. But what I mean by that is that the university oncology is not interested at all. They don't even look at the psyche. They laugh at each other, for example, always dead and then say, oh, this brain is the spider. Now he comes after me and says that it is cancer type or something like that. Then I always say, okay, I have met several hundred pancreas head carcinomas in the last 20 years. If you take the classification to Switzerland. I have never seen a hysterical personality out of 500 people with this diagnosis. Then you can't just go and say the psyche has nothing to do with cancer. Certainly more than 90 percent are trauma and much, much more are long-term stress phases that people either don't notice or just, I say, repress, ignore or consciously push away. But to make a separation at all, body and psyche, as a doctor, it's more cruel. I can't say it any other way. I can only admit that. Nice. Thomas, if we could now elaborate on some visions, what would a perfect interplay look like? Out of all these parameters. It comes back to tolerance, I would say, but also mutual respect and the assumption that there is still a lot that can be learned apart from fixed specializations. But the problem is also that many doctors don't have time, don't have an interest, and in many respects don't have an understanding that they could still need something. Because everything is going well as it is and why should you change that? But there are very small mini-examples, like with my clown doctors and others, where you bring humor into medicine, where you really have these elements that can actually have an effect without side effects, without anything else. This lie releases a hormone of happiness, gives hope and also gives the connection. It is a bridge between a sick child and siblings and parents and also the whole staff in the hospital experiences this butterfly effect, where you find this emotion of happiness and fun and play in an area where you usually don't find it. In palliative care where we were, it's just laughing. People come and say, why are you laughing here? We are in a place where laughing doesn't belong. Of course it belongs, because for me life is really so far-reaching until the last two seconds, where you let out the last breath. Everything defines life beforehand and you should work on the quality of life and not on any projections or anything else. Every second counts and every bond between family members and patients is given. That should go down like oil to you now. I just agreed with Thomas and the thought came to me again. If you want to bring the listener back to the whole thing, then I would definitely say, think from top to bottom. If we want to find out causally why something happened, then we shouldn't go for the substance. We have to go for the non-substantial. It's more complex, it's more organized in our existence. Few people are aware of that. There are so many studies that clearly show that social isolation, loneliness, being single, being widowed and so on are highly toxic factors that ultimately lead to morbidity and mortality. We all know that drinking and protective spaces are basic food. We don't even have to talk about that. It's logical. I mean, I can still be in contact with someone if I don't eat, if I don't drink, then I die. We just talked about it, we got an example like, we have a car accident and to see how it happened, we go to the car and measure the oil level. That's what we do. That's exactly how it is. Instead of looking at who I meet. I thought that was a nice one too. So, Lothar, you still. There is a beautiful picture where Snoopy says to Linus, one day we have to die, and then he says back, that's true, but until then, on all other days, we don't die. And what I find unbelievable with people is that they don't understand the happiness factor. They don't understand that if they're not happy, as you just said, we need more than just food. And what we need most when we are seriously ill is happiness. We call it double happiness, like this Chinese term. And that's what we teach, for example. We teach seriously ill people how to be happy. But when we explain this to people, the so-called psychosomatic, then they slowly come in. But here is the difficulty of the whole story. It's no use if I say to you, be happy now, or don't get angry anymore, or we have to do this or that. That's, as I always say, hard work. You learn to play the piano, you learn to play the guitar, you learn to sing. You have to study it. Also being happy. Just one more thing about the whole topic, this separation, specialization, generalization, however you want to see it. A few hundred years ago, a doctor was actually a life companion. They used to call it a family doctor and so on. They were people who also knew theology. They were people who were caretakers, shamans, whatever you call them. But they were there for the whole family. They hold the hand of a dying person. They didn't say, call a palliative doctor here. They were there. They also did the detachment of the children. They carried the grandparents to the grave and were also part of the family. They were integrated. And at some point, piece by piece, this image of a doctor, of a generalist, is simply broken away because you went into specialization. And then at some point, through different groups, you try to do this one thing again. And also really being there for the family and taking time and maybe sitting on the deathbed and holding hands. There's one more little ridiculous problem here. But very, very small. It only takes 20 seconds. A doctor gets plus or minus 30 euros for speaking in a quarter. As long as that doesn't change, I don't see a chance. Because a doctor is also an entrepreneur. How can he make money if he earns 30 euros in three months if he talks to someone? That's an incredibly big challenge that I don't see anywhere. But I don't see a possibility that a family doctor can do what we all want. It would have to be private. Yes, absolutely. Thank you very much for the round. Nice to have you here. And I hope to see you again soon. Dear viewers, I hope you were able to take away a lot from this wonderful expert round. Under Wikisana, of course, you can also find more interviews. Thank you for watching. I wish you a wonderful time. See you soon and bye.