Wednesday, August 4

Rabbit-Mir: “We are heading towards the health collapse due to the coronavirus”

Tuesday, February 9, 2021 – 18:07


Julin Conejo-Mir, at the Virgen del Roco Dermatology Clinic.

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Julin Rabbit-Mir. Seville, 1956. Before the pandemic, it was rare the weekend that this prestigious professor of Dermatology and head of this specialty at the Virgen del Roco, recently awarded, did not travel to a congress. Now, the few that are celebrated are virtual. But the transfer of patients does not stop.

Just by looking at someone’s skin, you already know a thousand and one things.
Well yes, because dermatologists are great explorers of the soul and not only of the skin. It is said “the skin is the mirror of the soul”, and it is so. With our specialty we develop a special scanner and, oddly enough, through the face you can see if the person is sick, has stress and now, with the Covid, I don’t even want to tell you.
But we don’t give the skin the attention it deserves.
Twenty or 30 years ago it was like that, but not now. The skin has become the protagonist. It is the largest organ in the body: two square meters. In addition, everything that happens inside is reflected on the skin, which is like a traffic light of what happens inside. Almost everything that is appearing in artificial intelligence to take control of everything: oxygen, blood pressure, glucose, cholesterol, we will put it like a tattoo. In the future, the skin will be like a huge window that will tell us about the health of the individual in any organ.
It sounds like science fiction.
But it is reality. In a few years, it could be by 2030, everyone will have a microchip in their skin that will tell us how the individual’s health is, and it seems phenomenal to me. Everything will be seen and the doctor can monitor it remotely. That is going to come, whether we want to or not.
Experts say that melanomas are the epidemic of the 21st century, why?
It is the fastest growing tumor in the last 50 years. Its incidence multiplies between 7% and 10% each year. It is an epidemic. In Australia, one in twenty people has melanoma; in the US, one in thirty; and in Spain, one in every eighty.
You work in one of the largest hospitals in the country, how do you see the coronavirus crisis?
When you work in a hospital like Virgen del Roco, you almost have to pay for it. In the pandemic, doctors and nurses have been seen to do their jobs with pride. This hospital is one of the best in Spain and in the world. And today’s doctors, not those of my day, are the best of the best. They are all gifted. I learn a lot from the residents every day. They think differently from us. They contribute a lot. I predict a huge level of health in Spain and more in Dermatology because they are the best in the MIR; it is the specialty that runs out first.
Some superbly prepared toilets with not so good working and salary conditions.
In Spain there has always been a kind of crusade against the doctor. Alfonso Guerra said not to stop until he saw us with espadrilles, and beware, I admire him very much! Later, Rajoy arrived and put a blow to the wing of all the civil servants because of the crisis. Almost 1,000 euros were lowered from our payroll for the doctors. It seems like it’s ugly to raise the doctor’s salary.
And now with the coronavirus …
The doctor is not a politician, he is a scientist, let’s make it clear. That is what is failing in Covid. Fernando Simn has all our admiration in his scientific facet, but he is not being a scientist but a politician and there he is failing; should resign. With Covid we have a health problem and the Government should pay attention to scientists, as other countries have done. And if Spain has to be closed, it closes. And they will tell us and the economy? But how much is a life worth? You can’t imagine what we’re going through by allowing the family to come over for Christmas. I am alarmed. In the Virgen del Roco, the occupation of beds with Covid patients rises every day. We are heading towards total sanitary collapse. The Government has to clearly tell the population that older people are dying and that, of the patients who are going to be intubated in the ICU, 12% will die.
Is the Government hiding behind the scientists?
Rather than hide, the Government is not clear or blunt. We do not think it right that the same techniques are applied as in the pandemic of the 18th century or the Black Death of the 17th century. They are doing the same. Scientists are sure to provide solutions that the Government does not dare to implement.
Do you support more restrictive measures against Covid?
Yes, because I have the theory of the doctor, not the economist. Fifteen or twenty days really confined, like in March. That is more profitable in lives, 90%, and for the economy, 10%. Nowadays it hurts the economy and is killing people.
Are governments succeeding in managing the health crisis?
Apart from the political affinity, I like how the Andalusian Government is doing it more than the national one. I miss that the national government develops a common policy, with well-marked margins on what to do, providing the innovation that the scientists tell it. None of that is being done. I see a government with folded arms. At first they were scared; they themselves passed the disease and confined the people. But you can’t have 17 different protocols, one in each community; Has no sense. And above all that they speak to me clearly. We want scientific solutions and we are here to help politicians, hospitals and our patients.
Do you give classes at the university? Can online sessions replace face-to-face teaching?
Go now! We are getting used to it, but the knowledge transfer that occurs when you are teaching face to face has been lost. The doctor is ‘down’, he is apathetic, we don’t make plans for more than a week … When we go to a congress, people think we are going to do tourism, but I have been to Prague for one and I have not left the hotel . That interaction with other doctors has been lost. Hence the apathy of the doctors.
A few months ago, the team of dermatologists at the Virgen del Roco Hospital received a national award for research on a skin tumor they developed over 12 years.
Yes, one of the most important lines in our unit is skin cancer. We have some brutal files. The Andalusian Health Service (SAS) has a very good digital network, which the previous socialist governments implemented for 20 years. It is better than that of other autonomous communities. We can do teledermatology from home, make prescriptions, access our files and see the patient better than in Madrid. We have been doing teledermatoga for 18 years now.
What advances will we see in the coming years?
Work is underway to get a robotic consultation assistant, who, if necessary, will spend two hours with the patient asking questions and then make a detailed report. When the patient passes with us, we already have a huge diagnostic approach. And so there could be, for example, five doctors consulting and five robots helping.
With these robots, is the figure of the doctor in danger?
No. At first, with teledermatology, we thought it was an attack on the specialty, but it has been the other way around. Increase quality, increase service, and more patients come. We will improve, but not remove the doctors. The finesse and the sixth sense of the doctor is an apprenticeship. In Medicine, there is 50% science and knowledge and another 50% art and know-how. Most of the failures are not due to the diagnosis, but due to problems with adherence to treatment. And that is never going to be done by a machine but by the doctor.

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