should be transparent and accountable when making such decisions, as these concerns need to be thoroughly evaluated. Too many of my colleagues are now reporting this sort of irrational approach to administration, which has created great insecurity for professionals who want to maintain programs at major healthcare institutions, because of radical and frequent changes in the leadership and, hence, the direction of health institutions. There was no due process and no forum to openly debrief our feelings about the sudden end of the program, neither for me nor all the people working for and with me. Such examples discourage young professionals who would otherwise choose a career in academic medicine. This is where the checks and balances need to be put in place. Administrators must present clear reasons and explanations for such decisions. I see a brain-drain move and a level of instability created in many strong programs because of those kinds of decisions and rogue administrators. While many decisions may prove to be financially sensible or logical at a time for programs that are seen as a financial drain on the system (this was not our case), not all care can be profitable in medicine. There are “economically lost leaders”, and that is particularly true for medical specialties. Tendering the issues of finance and care takes special administrators and physician leaders. Unlike what we see in the banking and financial industry, medicine and health care must be looked at through a different lens. I had a conversation with a parent whose son had made multiple suicide attempts, and when discharged from a psychiatric hospital in Miami after his last Baker Act, he reported feeling less than a human. He had been stripped of all his clothes and placed in a locked-downward with highly psychotic patients who had no sense of reality. By the time his mother discovered our clinic, Design Neuroscience Center in Doral/Miami, Florida, she had exhausted all the resources she could access, but it had made her son worse. His mother made a profound statement that made me sit up and take note: “I cannot imagine how many people leave the emergency room, doctor’s office, or trauma center and never get a follow-up after a concussion or TBI.” We have no idea how many of the patients who leave acute-care settings after a TBI/concussion go home and become depressed, anxious, and suicidal, lose their jobs, have challenges in their marriages, perform poorly in school, and just literally experience some extreme breakdown in their lives. Very few studies have been performed on this subject. If you are a medical professional, think for a moment about all those patients whom you discharged and never saw again. What happened to them?
Well, here is the real deal. Many of them are living productive lives in society. But there are also those who get arrested or become drug addicts, engage in antisocial behavior, and have trouble integrating with society or have chronic emotional, physical, and neuropsychological disabilities. Hospital administrators and physician leaders, think of those clinics you could have invested in but didn’t because you wanted to divert resources to more lucrative health care ventures. Think of the program you could have funded to train more doctors, therapists, and psychologists to treat this traumatic condition.
Having said this, at the time of the publication of this book, I was on the frontline in the field, serving as Medical Director of the Sports Concussion Program at the University of Miami. I am forever grateful for this opportunity to be trained and subsequently to work for this fine institution.
I am about to brag just a bit about the very positive aspects of the Concussion USports Program at the University of Miami. I feel proud to see that despite many challenges, this program has advanced beyond our wildest dreams with grants from major institutions, while also meeting the needs of injured athletes. Our fearless leader, Dr. Gillian Hotz, has done an outstanding job in moving this program forward. We now serve most of the sports injuries from the high schools (third-largest high school system in the nation) and some of the universities in Miami-Dade County. The USports Concussion Clinic by working with athletic trainers, has built a unique system of monitoring, evaluating, and following brain-injured athletes. This program has been in place for many years and the real recognition comes from the people we treat by solving complex issues associated with concussions, thereby allowing them to return to play and to the classroom, and to lead successful lives.
Since my departure from the Jackson Memorial Health System in 2014, a hospital affiliated with the University of Miami Miller School of Medicine, I have been fortunate to have created a comprehensive brain injury program (Design Neuroscience Center) in Doral/Miami Florida, where we attend brain injury patients in a multidisciplinary program with 5 neurologists, 1 PM&R, a team of neuropsychologists, physical therapists, occupational therapists, and speech and language therapists. We treat patients at all levels of injury and recovery and from the local and international communities, following many of the principles of the BHET methods. Clearly, the training, experience, and opportunity to lead at Jackson Memorial Hospital and the University of Miami prepared me for this venture.
Our community needs experts who are sincere, hardworking, and smart and can build teams providing a comprehensive program that works. Administrators who are touched by science, the patients, and their humanity. Of course, there is the need for financially savvy individuals who can think out of the box. The key to success is building the right team and doing all within our power to preserve a sustainable working system. It can take years to hone talent and gather experience, but these can be thrown away by an uncalculating political establishment in an academic setting or hospital system.
Individuals involved in the evaluation and management of TBI and concussion represent a really small community, and stakeholders must be aggressive in preserving such systems of professionals and organizations.
I want to express my opinion in the most profound way: when you look at what is going on in the field of brain injury and notice the chaos, you can understand why it is so difficult to find fundamental answers for the care and treatment of TBI/concussion patients. On the one hand, the consumers and patients are screaming for answers. On the other hand, the people who are in a position of power in the medical, administrative and political establishment are a generation behind, promoting traditional values (confrontational intelligence), egotism, elitism against a backdrop of tokenism, and limited diversity. This is not only about culture and preference but also about ideas and looking at the coin from both sides. Many in our healthcare and business systems will tell you they believe in diversity and freedom of expression. However, their actions clearly reflect that they do not give themselves a chance to think out of the box. In the spirit of protectionism, they can throw away the most important ingredient without even realizing it. Institutions are building edifices that carry great names from donors, but there is little focus on programs and people which can make a difference. It is time for our leaders to not only invest in buildings, but we must also invest in people and programs. At a time when one of the hottest issues in medicine is brain injury, I encourage hospitals around the country, which are addled about what to do and where to go, to wake up and make a difference. We can address this issue by building a continuum of care for TBI/concussion patients together with the support of the community. This system is badly needed in our community and the country. Unfortunately, very few out there have the knowledge, experience, and the desire to do so. This must change!
So, what else is hindering advancement in TBI/concussion?
There is another controversial subject that I believe has negatively impacted the TBI and concussion movement in the USA. While I may be castigated by my colleagues for the very mention of this subject, I cannot finish this book without it. There is a huge fight going on in the medical field among physician specialties to determine who should treat this disease. Despite the limited number of professionals treating persons with TBI/concussions, there is a kind of warfare going on behind the scenes between the physician specialists. Leadership’s role is to get people to work together and make peace so that we can preserve programs that need to be preserved, thus creating sustainability and better outcomes.
You see, for more than 20 years, there were no physical medicine and rehabilitation (PM&R) specialists in our program at Jackson Memorial, and pretty much all of neurological rehabilitation was controlled by neurologists. When the PM&R physicians were introduced to our institution, the administrative and medical leadership allowed the development of a very toxic and competitive environment to thrive instead of uniting the PM&R
