Z-Netwerk interview, 2010
At the end of last year, Marc Schröder left Slotervaart Ziekenhuis to join Bergman Clinics’ Back and Neck Centre in Naarden. This clinic specialising in Movement Care employs orthopaedic surgeons and neurosurgeons. ‘This is a good place to continue my development.’
What does neurosurgery involve?
The scope of neurosurgery includes operations of the central nervous system – i.e., the brain and the spinal cord – and their bony encasings. These encasings – the skull and the vertebrae, respectively – closely enclose the nervous system. Neurosurgery also includes operations of the peripheral nervous system, e.g. nerves which run from the spinal canal to the limbs. Until recently, I performed brain surgery as well as spinal and peripheral surgery. However, I noticed that many new operation-supporting technologies were being released, allowing one to operate on the spine without causing much tissue damage. This greatly appealed to me.
So why do you only perform spinal surgery these days?
Many neurosurgeons do still perform lumbar spinal hernia surgery, but generally in addition to the many other duties they have in their capacity as brain surgeons in an affiliated regional hospital. Spinal surgery has become a widely inclusive field that is developing very fast. Choosing to focus on spinal surgery only has allowed me to really specialise in this field, whereas many other neurosurgeons are increasingly choosing to specialise in brain surgery. At Bergman Clinics’ Back and Neck Centre, many aspects of spinal surgery are practised. Many people are now growing much older than they used to. As a result, there has been an enormous increase in degenerative disorders of the musculoskeletal system, and therefore in degenerative disorders of the spine. These disorders nearly always present with painful symptoms. Pain can ruin a person’s life. Surgically reducing or removing a person’s pain gives me great satisfaction.
Can you name an important development in your field?
Small incisions, i.e. minimally invasive surgery, have become quite important in the performance of surgery, and therefore in the field of spinal surgery. Using this technology significantly benefits patients in that they will make a speedier recovery, are unlikely to suffer inflammation, will have smaller scars and will require less time to complete their rehab. I hope to be able to specialise even further in minimally invasive surgery. At Slotervaart Hospital I used the opportunity I was given to develop my skill in this field and to specialise in it.
Why did you leave Slotervaart Hospital to start working at Bergman Clinics’ Back and Neck Centre?
Bergman Clinics had been following my efforts in the field of minimally invasive hernia operations for several years. When they were developing plans to establish a new clinic in Naarden specialising in treating disorders of the musculoskeletal system, whose treatments would be fully covered by Dutch health-care insurers, they approached me. I found the building quite impressive. Their plans included a recovery room holding ten beds, two mechanical ventilation beds, four state-of-the-art operating theatres, MRI scanning equipment of their own and forty highly luxurious private rooms. I was granted the opportunity to expand the innovations I had initiated at Slotervaart Hospital in a uniquely professional setting.
Is this why you came to Naarden?
It wasn’t the only reason. In the summer of 2010 I was the first surgeon in the Benelux countries to test a mini-robot that was able to indicate very precisely in which direction the screws used to fixate displaced vertebrae must be placed in the spine. The robot transcutaneously – i.e., through the patient’s skin – showed the direction of the screws to be implanted by means of a metal thread. The surgeon then implanted the screws along this line. The results were astounding. Post-operative CT scans of the spots that had been treated showed that the final result was identical to the operation planned beforehand. I told Bergman Clinics that I’d join them if they were willing to support this robot technology. They honoured my request for a Spine Assist robot.
What are the advantages of this robot?
It takes less time to perform surgery, and both the patient and the surgeon are subject to less X-radiation. There is a 98.7% likelihood that the position of the implanted screws is correct, which means that no revisional surgery will be required, and no blood vessels or nerves will be hit. So it’s quicker, more comfortable, and most of all, safer. Human hands can’t be this precise. I think it’s an enormous breakthrough.
How are the hospital and Bergman Clinics’ Back and Neck Centre different?
The difference lies in the level of service patients receive. When I perform an MRI scan here, the patient will be back with me in an hour, and I’ll be ready to suggest a treatment plan. That’s unheard of in our country. Yesterday we had a patient in the outpatient clinic who went into surgery today. This place allows me to do what I love and what I’m good at. This place is all about providing great service to its patients. I’m sure this helps them make a better recovery, too. I’m fortunate to be working here.
How did your colleagues at Slotervaart Ziekenhuis respond when you told them you’d be leaving them?
Very well. They thought I was making a brave decision. In a way, it was a leap into the dark. I was given the opportunity to establish a unit according to my own ideas. Not many specialists are given such opportunities. This was the right time for me to take this step.
How does Marc Schröder remain an enthusiastic surgeon?
Because of this minimally invasive surgery. Backache or pain in the neck can ruin a person’s life. Helping patients get rid of their pain gives me a lot of satisfaction.
Independent-minded patients – are they an advantage?
Independent-minded patients keep specialists on their toes. Sometimes patients find it hard to accept that certain things can’t be done. For this reason, it is important that a surgeon explain very carefully to his patients what a proposed treatment involves or why he won’t be able to help them. It is important that patients understand my point of view. Providing a good explanation often helps patients tolerate their symptoms a little better. I spend a lot of time on this during the intake interview. If a patient has a good understanding of the treatment plan, his or her recovery will be positively affected. So as far as that’s concerned, independent-mindedness is a good thing. However, specialists do become very vulnerable when people leave anonymous messages about them on patient forums on the Internet. It is all too easy for anonymous people to damage an excellent specialist’s career without any grounds. This could be prevented by ensuring that people can’t post such messages anonymously, so that doctors can at least defend themselves against the allegations. This is being looked into at present.
If you were the Minister of Public Health, what would you change?
I would promote the development of specialist hospitals – like Bergman Clinics’ Back and Neck Centre – because they provide better-quality care for a large number of medical conditions. As a country, we are lagging behind other countries, where hospitals specialising in certain types of patients are much more common. Such hospitals have more efficient operational management, which means more money is available for innovations and customer service. Moreover, medical specialists are able to spend more time doing what they’re good at. In other words: higher volume, better outcome. Patients receive friendly care, overheads are low and decisions can be made quickly.
Health insurers should do more research into the innovations that are being introduced. Health insurers are not always up to date on the latest developments in our field of medicine. It is remarkable that one health insurer rejects minimally invasive surgery, whereas another loves buying it. That’s weird, considering the advantages involved, such as cost savings and patient-friendliness. Often, insurers won’t purchase innovative types of surgery because supposedly, there is no evidence base for it. But really, if a tiny incision gives you the same result, technically and medically, as an open wound, isn’t the choice obvious? If I were the Minister of Public Health, I’d like to do something about that.
Last but not least – who is your role model?
I was inspired by my father, who was a nerve doctor – basically, a cross between a neurologist and a psychiatrist. As far as the doctor-patient relationship was concerned, he believed in ‘being highly accessible, while keeping a bit of a distance’. That’s the reason why he always wore a white lab coat. It wasn’t just for reasons of hygiene. It was to create more of a distance, which oddly allowed him to get closer to his patients. It’s not true that doctors get closer to their patients by taking off their white coats.