Today, BCM Lifestyle invites Asst. Prof. Dr. Weerachai Nawarawong the skillful Cardiac Surgeon at the Heart Center of Excellence, Bangkok Hospital Chiang Mai,
to talk about a proactive approach on which focuses heart patients but also means their circumambient context: ‘family’, as the morale of patients, compassionate partners
whom will be directly affected in all dimensions of the circumstance from before and after surgery, the rehabilitation to follow up phases until the patients completely recover.



The Heart is a Patient and a Family


"The so-called Family Meeting is an all present meeting where the medical team aims to create a comprehensive knowledge for patients and their families in simple language,
allowing close inquiries for a mutual understanding of the treatment plan." Medical Director and Patient Care Unit Director of Surgery, Bangkok Hospital Chiang Mai starts the conversation.



In order to gain complete confidence and knowledge of treatment for our patients of the Heart Center of Excellence, we bring the concept of a 'face-to-face family meeting' to the ACS Pathway,
a uniformed plan for any ischemic heart disease patients. As a result, the treatment process is more practical and measurable on the international standards. This enriches our services differently from other hospitals
that hold such meetings only in cases of high severity and in critical patients who cannot make their own decisions.


"Adding ‘Family Meeting’ in the Pathway has a significant positive impact on patients for increasing their insight aspects of medical treatment, diagnosis, dispensing and surgery.
Sometimes providing a medical pathway is too complicated for patients and their families to understand; by seeing the whole multidisciplinary team is a growing understanding of the symptoms of the disease
and the treatment guidelines to which contribute the cooperation of all parties.”  The heart Surgeon further explains
“recently, we hold family meetings before and after cardiovascular surgeries and are going to expand to any cases of ACS Pathway, covering the not-large-yet-very-serious treatments,
e.g., Cath Lab, Stent, Balloon Angioplasty which its patients are still of sound mind--without anesthesia required."


The Patient Language Concordance


"We normally speak a patient language, sometimes Lanna dialect" the surgeon smiles.

In fact, family members also want to know what will be next? what will be the symptoms afterward? How do patients need to behave? how would relatives participate in?
After cardiac surgery, family meetings are usually held in the inpatient room in order to inform progress as well as to prevent unexpected surprises.  There are some cases, we move to bigger rooms, to offer more on-screen information.
By this, the location of the meeting varies, contextually depending on the number of doctors, family members and the content to be discussed. Importantly, progress notes will be recorded in writing by a Cardiac Nurse Case Manager.


Cardiac Rehabilitation


After cardiac surgery, at a stage where patients are unconscious and under supervision in the intensive care unit - ICU, specialists are able to shortly update the progress to patient relatives at the waiting area in the vicinity.
When the patient starts to recover, postoperative care will immediately enter a stage of ‘Cardiac Rehabilitation.’ As a multidisciplinary team, Cardiac Surgeons will discuss with Rehabilitation Medicine to jointly customize a method of physiotherapy,
a postoperative reconstruction of the heart.

Unlike traditional methods where patients are suggested to lay motionless in bed. "Our cardiac rehabilitation process begins as soon as the patients open their eyes"
mentioned the renowned heart surgeon, who has been caring for heart patients for more than 30 years.

The collaboration of a multidisciplinary team from the Heart Center of Excellence and a Cardiac Rehabilitation Center consisting of Cardiac surgeons, Cardiologists, Physical Medicines and Rehabilitation Physicians, and dietitians.
To keep the recovery humming along, rehabilitation can be started without waiting for the patient to revisit after discharge from the hospital, which is a waste of opportunity and slows down healing.



"Shortly after recovery, Physical Medicine and Rehabilitation Physicians will closely advise patients to start moving their arms and legs in bed, or exercising their lungs.
Until later when the patients are ready, we will get them up walking, even with IV line, to prevent postoperative complications. Especially elderly patients, the more they sleep in bed, the more complications patients are at risk,
such as sputum blocking up the bronchus and cause pneumonia, slow bowel function, blood clots in legs, pulmonary embolisms, which are even more dangerous."


Our multidisciplinary team found that Cardiac Rehabilitation is a proactive recovery plan to give patients more confidence in their safety under the supervision of rehabilitation specialists.
A performance of heart function and blood pressure is even better.  A recent case of an 80-year-old cardiac patient who is so pale and exhausted, cannot walk nor eat on his own.
After receiving heart surgery and our complete care of Cardiac Rehabilitation in the process of ACS Pathway, the senior patient can stand and walk with a walker shortly after surgery.


As a part of Bangkok Hospital Chiang Mai, JCI accredited hospital, the Heart Center of Excellence conveys its concept of Heart-based Hospitality through meetings between doctors and multidisciplinary teams on various occasions.
This regularly helps to cause process development in terms of enhancing patient care protocols both physically and mentally.
With respect to patient’s rights and understanding the all-around context based on our pivotal point: Patient Safety, it is the reason, “we are the Strong Heart Family”