From Sardinia to Switzerland, passing through Milan after various stops in the US and northern Europe. 48-year-old Andrea Cardia, a graduate of the University of Cagliari, is the new head of Neurosurgery at the Institute of Clinical Neuroscience of Italian Switzerland, which has its headquarters at the Lugano regional hospital.
Freshly appointed, he comes from IRCCS Humanitas, where he was responsible for oncological and vascular neurosurgery. Clear ideas since I was a child, "since I was 5 years old everyone remembers that I wanted to be a doctor and from my 10 the neurosurgeon in particular", he explains to L'Unione Sarda.
Is Lugano your choice or was it chosen?
“I had 'open' competitions and I answered a call for a primary position in which certain characteristics were asked: an oncological and spinal vascular skill; it is difficult to have both, in my case they were ".
Selection: how does it happen?
“First on the CV, from about thirty candidates it went to 10, then to 5. Then two auditions with 8 people including an external commissioner. When I won the competition it was just the beginning because from there they begin to really 'study' you, for example with four and a half hours of psycho-aptitude tests, also to bring out any leadership skills, which are essential; a sort of site visit in Humanitas in Milan to see me operate and to speak with the head physician, with the rector of the university, with the medical director and the head of intensive care, in short, with the people who could know me better. A - positive - opinion was finally expressed at a distance and I accepted the assignment on a long-term development project, with a three-year and five-year plan ”.
In his curriculum there are Stockholm, New York, Helsinki; you also know the Italian reality for having worked in Milan and Cagliari: what differences did you find between health systems abroad and ours?
“The first is absolutely the one about doctors and the structuring of their preparation, that is, how they are trained. Everywhere abroad there is a basic education imposed, less dependent on the individual and more on the structure. In Italy we have some of the best doctors in the world but a lot depends on ourselves. I mean that excellent professionalism comes out, even if the structures do not foresee a performing path giving a lower baseline than other states ".
Are you referring to specialists?
“Once you have your degree in hand, and just study for it, you are not a doctor. The specialties are schools in which, until recently, the choice of what he wanted to do depended on the person, there is no selection ".
So there is meritocracy abroad. Why not in Italy?
“Compared to the past there has been a great improvement, I think the mistake is that of not making direct assumptions, you do not choose the person but select them on the basis of points that can instead be read in a discretionary way. In Switzerland, for example, personality comes out ”.
Does your profession require renunciations?
“Renunciations and many sacrifices, especially as regards the distance from the family, mine stayed in Milan and I go back on the weekend. It is a job that represents a fundamental component of my person and you have to balance everything otherwise you will never reach the goals you have set for yourself ".
Does medical commuting from other countries exist in Switzerland as in Italy?
“A lot, because the specialists in my field are few and often they do not have neurosurgical training with also the ease of communication due to the language, and therefore they have to 'fish' from abroad, usually from German or French Switzerland. I am probably the first Italian neurosurgeon, or rather Sardinian ".
The Swiss health system is only private: how - if - a cancer patient is treated if he has only basic insurance?
“Insurance is in fact compulsory, who was born here, if he was hired or if he is unemployed, in short, anyone has it. It's not like in the United States, everyone has access to treatment with their insurance ”.
Do you operate or do you have a managerial role?
“I work, of course. Now I have just been appointed, I am finishing the paperwork, then I will start in the operating room. However, I will also have the role of coordinator which is crucial because Lugano is the most important hospital in the Canton ”.
What do you mainly do?
“Vascular interventions, or even for tumors, spinal. I can't make an estimate, let's say about a hundred complex interventions, in total about 4 thousand as first operator ".
What are the most common pathologies?
“As for the spinal part, the degenerative part that is growing due to the phenomenon of an increasingly elderly population, canal or cervical stenosis. While for the cranial part the tumor is benign or malignant ".
Today we talk more and more about neurosurgery 2.0, what is meant?
"The one based on all the technologies that are currently being developed to bring neurosurgery to a higher level, with neuronavigation systems for example, or with interventions on an awake patient or even with the use of robots, which always takes hold Moreover".
Will machines come to replace humans?
“I never believe that. The robots are the surgeon's precision guide, which allow the margin of error to be reduced to a minimum, but they cannot do what the human hand does, also for reasons of space that is often very limited during a cranial surgery ".
A theme very dear to her is that of the training of young neurosurgeons. It is said that in ten years there will be no more doctors, does it also apply to specialists?
“There is a reduction in some branches, in particular those that involve very important risks. It must be said that complaints are received perhaps against a salary that is equal for all branches, but the insurance premiums are not all the same, as are the risks. This is why many choose to do less, and also the vocation has decreased a lot. Over the years, the specialists have turned to more and more precise jobs and those who are needed come in, more or less. Mine is not a huge field, there has always been coverage of places, and indeed we have been able to choose ”.
Trainees are increasingly leaving Sardinia, what should be done to keep them or to make them return?
"Convey financial resources to one or two hospitals and that's it, to make a name for having Brotzu at a very high level as it has been in all fields and to make technological investments to attract the so-called 'brains' from abroad".
Would a neurosurgeon with his CV be valued on our island? Would you go back there?
"If I had the possibility to operate and choose my work group, under certain conditions, having assessed the population basin, I would think about it".
Will we return to a normal future with or after Covid?
“I am an incurable optimist, I answer absolutely yes. There hasn't been a general lockdown anymore, so we can talk about an improvement. It will take a few more years, then we will still hear about Covid without it having such a violent impact on our lives ".
Switzerland has adopted fewer restrictions for the epidemic than Italy, more attention to the economy than to health: does it pay for this choice?
"They were absolutely superimposable realities, perhaps the situation was slightly better than the Italian one, in the past however very similar, the anti-contagion provisions have existed, but the failure to declare some data and self-management, let's call it that, have allowed to arrive at the current state of relative tranquility ".
What do you see in your future?
“I'm not used to seeing life as a climb, that when you reach one grip you immediately look for the next. Now I concentrate on the project that we have set out to carry out, on the technological implementation, on the reconstruction of the team, and on the increase from a scientific point of view, even from a university point of view. Then we will see, maybe another destination, maybe other proposals, but in general change is not what I aspire to ".
And does Sardinia always have a place in your mind?
“Always, always. My parents are there, it is not only the place of the summer vacation, even on the weekend if I am free I come back. Now less because I no longer have my studio in Cagliari, but my being Sardinian is independent of this. Even if I have lost my accent a little, when I am disappointed it all re-emerges ”.