- 5 weeks ago
Despite evidence women are the better surgeons, they’re still underrepresented in clinical leadership. As patients, they’re also more often misdiagnosed. The root cause? A healthcare system historically dominated by men.
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00:05the anatomy of the human body sure it's complex but we've been studying ourselves for centuries
00:11and know what we're made of right doctors today are supposed to learn the names and locations of
00:18every bone muscle and organ and they do at least in men but how do you explain the researchers
00:25have just discovered structures in the female pelvic area that don't appear in textbooks
00:34that's and much more from the world of medicine this time around on tomorrow today
00:43researchers have rediscovered a forgotten bit of female anatomy cells of the ovary are pictured
00:50here in red but what's that green thing i had no idea what this was because the structure was not
00:57really depicted in any recent textbooks or literature so i went to my mentor blanche cable and and she
01:05wasn't really sure what it was so we pulled out some of her old textbooks and eventually realized
01:10that this was the the radio very eye radio very eye a tissue that was first described 150 years ago
01:18but then disappeared from anatomy books so then once i saw the structure and realized how big it was
01:26and did some characterization found that it was associated with the ovary throughout development
01:31um i just couldn't stop thinking about it so i really started to launch more studies into its
01:37characterization from there investigation showed that the radio very eye shown here in turquoise
01:44partially surrounds the ovary it might play a role in hormone balance and be important for the
01:50embryonic development in the reproductive organ and there's a likely connection to the development of
01:57cysts although it's found in other female mammals as well as humans it no longer appears in scientific
02:04drawings because scientists long thought it didn't do anything not anymore we're very convinced at this
02:13point that it must serve some function we don't we do not think it's useless or vestigial the fact that
02:21it remains throughout life that it is such a significant structure um really indicates that it must serve a
02:29purpose the radio very eye is not the first part of the female anatomy to be historically underestimated
02:36the clitoris was as well meet mandy mangler a chief physician at several clinics in berlin who advocates
02:43woman-centered gynecology when you look at anatomical drawings in your doctor's office depicting the
02:50female pelvis for example you generally see the uterus and vagina but in 95 percent of the images there's no
02:56clitoris the clitoris is a structure about 10 centimeters in size that plays a major role in sexual
03:05arousal in women i find that difficult it's like drawing the male pelvis without a penis and there's
03:13a lot of history involved women weren't allowed to study medicine for a very long time for example and a
03:20few hundred years ago the anatomists were all male and kind of members of a club they did study and
03:28describe the clitoris but didn't really know what to do with it or what it was for and so little
03:34by
03:34little this knowledge disappeared from anatomy books a situation that's slowly changing for instance
03:45in the anatomy books medical students in germany used to study for exams up until 2022 the clitoris
03:52was almost never depicted there but new additions now include a correct anatomical illustration of the
03:59female reproductive organs if the redeovarii were part of the male anatomy jennifer mckee says it would
04:06have been studied seriously at a much earlier point the female reproductive system and the female body the
04:14female health has been majorly overlooked and i think that's no secret at this point the redeovarii is
04:22finally receiving more attention and researchers hope to soon shed light on the role it plays in the
04:29female body did you know that in women heart attack symptoms are often different than they are in men
04:37they typically experience severe chest pain while in women it often manifests less clearly as nausea
04:44shortness of breath or back pain because symptoms like these are often regarded as harmless heart conditions
04:51in women are more likely to be misdiagnosed
04:58how christina pingel perceived her body and her symptoms and how doctors interpreted and diagnosed
05:05them almost cost her her life she tells us about it when we meet up in her favorite cafe
05:14i had my first symptoms when i was 26 and realized that something was wrong i went to the doctor
05:22in the
05:22emergency room a lot because it got worse over time at some point my heartbeat grew irregular i'd almost black
05:32black out and had a lot of pressure in my chest i just got more and more frightened
05:39she had a serious heart valve defect and needed surgery but years passed before a female cardiologist
05:46finally diagnosed it in all that time about 10 years until i was finally diagnosed i kept saying over and
05:55that something was wrong and i kept hearing back that it was all in my mind that i was imagining
06:01everything
06:02even my real physical symptoms and no one investigated not in emergency rooms not in medical practices
06:10it was just really bad
06:14her mother had similar symptoms and suffered a serious heart attack at 33. christina was nine at the time
06:22she was resuscitated after 15 minutes and after that was severely disabled and in a nursing home for 25 years
06:33a pacemaker would have prevented it by balancing her heartbeat then it wouldn't have happened
06:40but just like with me they told her she was a young woman and it wasn't that serious
06:46medicine based on male bodies sabina artel prigioni wants to change that
06:51she's a physician who researches gender sensitive medicine when we think heart attack we think of a
06:59stressed out middle-aged male manager who also smokes and maybe eats poorly that's someone who has a
07:05heart attack when we think of osteoporosis we think of an elderly post-menopausal woman but anyone who
07:12doesn't fit the stereotype has a higher risk of delayed diagnosis two and a half years ago she founded a
07:20statewide gender sensitive medicine network the term gender is now loaded says the doctor but it plays
07:28an important role in medicine if i go to a doctor and am not believed or only offered certain diagnostic
07:36procedures late if i'm perhaps given different treatments because it's assumed i will deal with it
07:42differently these are gender aspects and that also clearly means that gender actually affects us all
07:50after her symptoms weren't taken seriously christina pingel wrote a book about her long ordeal
07:56she also provides information on social media about the gender health gap and since having heart surgery
08:03she finally feels good again if you ever need surgery you'd be better off if it were performed by
08:12female hands rather than male ones at least that's what research suggests in a canadian study from 2023
08:19over a million patients were examined one year after their operations the result the sex of the operating
08:26surgeon matters with male surgeons one in four patients had complications with female surgeons it was only one in five
08:38an operation on the aorta the body's largest artery which runs from the heart down to the pelvic area
08:45today heart surgeon norah gobel has to replace one she opens up the rib cage
08:53the procedure is particularly challenging because the patient on the operating table is a woman
09:01women are generally smaller so everything is smaller including the structures you operate on
09:08and that can sometimes make things more complicated
09:13female heart surgeons are still a minority in germany even though studies have shown that women who
09:19are operated on by a woman have a better chance of recovery
09:27there's study data showing that female patients actually have a higher risk of complications and mortality
09:33if they're operated on by a male surgeon
09:38goebel is a specialist for operations on the aorta when a bulge in it forms an aneurysm it has to
09:46be
09:46treated quickly if the vessel ruptures most people don't survive this patient was lucky
09:55you're aorta had a tear we replaced the section that was threatening your life
10:04the aorta is not exactly the subject of lots of research but goebel remains fascinated by the 40
10:11centimeter long blood vessel that was officially designated an organ last year the aorta used to be
10:18divided up to some extent by medical disciplines with different parts of it treated by different
10:24specialists cardiac surgery focuses on the part of the aorta close to the heart while vascular surgery
10:33traditionally focuses on the part close to the abdomen and everyone tends to stick to their own
10:40area and neglect the rest but being viewed as an organ like the heart or kidneys means the aorta will
10:51now be considered in its vital entirety because when it works everything is fine it transports five
11:00liters of blood per minute from the heart to every region of the body and destination organs
11:05and if it stops working like if it tears life ends very quickly who has an aortic aneurysm when
11:18and why that's the focus of a study at goebel's hospital in stuttgart anyone over the age of 18 who
11:26lives in the area can now have their aorta measured for it until now health insurance only paid for screening
11:33in men over 65 but we also know that more than half of the ruptured aortic aneurysms that come for
11:43emergency surgery don't fit into the screening plan patients are either younger or of a different gender
11:52so we also saw this as an opportunity to launch our screening study
11:59over a thousand people between 21 and 91 have taken part thousands more are on a waiting list interest
12:07is huge and we can already say based on the figures we've screened that rates are higher than we expected
12:17the ultrasound exam covers not only the abdominal area but also the chest
12:24this is the first study on aortic aneurysms for felix heitzman everything looks good
12:32one measure checked during the exam is the large blood vessels diameter
12:38heitzman thought he might be at risk because he already has problems with his circulation
12:46i've had a vein on the right side taken out and had really long-term problems with wounds healing on
12:53my foot so i was interested in finding out whether everything was okay with my other blood vessels
13:01the doctor tells him that the measurements are normal for his age and his risk should remain low for at
13:08least a decade if aortic disease is detected early in development says nora goebel then surgery isn't
13:17very risky her study will take at least five more years and she's happy so many people are signing up
13:24for screening the aorta is after all close to her heart
13:32every second counts when someone has a heart attack speed is of the essence getting help fast
13:39dramatically improves the victim's chances of recovery the first step is if at all possible
13:44to call emergency services nowadays the professionals can bring along equipment like a heart lung machine
13:50or ecmo and that's helping save lives the phone rings at the emergency services hotline the caller reports
14:01that a woman is lying on the ground that she stopped breathing and is turning blue
14:09because first responders have to start resuscitation as quickly as possible a specially equipped vehicle
14:15sets out with an emergency team on board it carries three specialists and a mobile ecmo a small heart
14:23lung machine i don't really remember anything from then on i was totally out of it and only woke up
14:32five
14:32or six days later in heidelberg in the intensive care unit of the intensive station angela langer had
14:39suffered a severe heart attack she only knows what happened next from what she was told later the
14:45emergency physician arrived first it was a good team we took all the right measures everything
14:52strictly according to the guidelines but we couldn't get the heart beating again that's because she had
14:57a main coronary artery infarction a very large vessel that supplies the heart with blood was blocked
15:04completely in that situation normal resuscitation won't work the medical intervention car is a high-tech
15:13emergency vehicle that brings intensive care to the streets angela langer was quickly hooked up to
15:19the mobile ecmo this is a one-shot system that's specifically for a single patient this box has been
15:26prepared and is in the vehicle so we can connect things straight away saving valuable time the so-called
15:33oxygenator is in there it's an artificial lung
15:38the compact and portable device can take over the function of the lungs and heart
15:44it works like this blood is taken from a large vein in the groin enriched with oxygen then pumped back
15:52into the body via an artery during reanimation the device always replaces the function of the heart and
15:59lungs ecmo a term many remember from the covet 19 pandemic this is what one looks like in an ic
16:07unit
16:10this device is supplying oxygen to this patient with severe lung failure you can see that the dark
16:17oxygen-poor blood coming from the lungs enters this oxygenator and comes out a brighter red on the other
16:23side enriched with oxygen so it replaces the function of the patient's lungs and this is the connecting
16:31tube where oxygen is taken in from outside to be absorbed by the blood hooking up a patient to an
16:39ecmo
16:40as fast as possible is not exactly routine even in an ic ward so emergency personnel have to train
16:47regularly in simulations like these to ensure it'll work on the street because seconds count the team
16:55is usually made up of three people each with clearly defined tasks and that's an addition to the emergency
17:02physician and paramedics at the scene so good teamwork is key the blood vessels have to be connected
17:11properly to the device no easy task while cpr is ongoing the ecmo is connected to the gas supply
17:23the tubes are ready and just need to be clamped
17:30at some point the exercise no longer feels like a simulation
17:42but ecmo also has limits if patients are not immediately resuscitated by helpers on site
17:49it's not an option heidelberg has always been a pioneer in emergency medicine at the beginning of
17:58the 1960s it saw germany's first emergency doctor deployment vehicle a forerunner of today's highly
18:05specialized vehicles bearing mobile heart lung machines it's definitely a crucial module for the
18:14future of the emergency medical services especially for critically ill patients because it's a module it
18:20offers the possibility of bringing ecmo into play in a cardiovascular distress scenario however we're very
18:27aware that options for introducing it everywhere are very limited without the ecmo it's very likely the
18:34patient would not have survived i would have had to pronounce her dead on the street angela langer is
18:42doing well after rehab she's continued to exercise regularly and is also working again the fact that she
18:51can is in no small way thanks to a small box that can play a big role in saving lives
19:01on to another topic skin cancer is the most common type of carcinoma worldwide but getting an appointment
19:08with a dermatologist can be tough in many countries long waiting times are the norm now new technology could
19:16help speed things up you should close your eyes the flash is pretty bright the launch of a new technique
19:26for identifying skin cancer a high resolution camera photographs patients striking various poses shots are
19:34taken with different levels of light for later diagnosis called a checkup box the device can be placed in any
19:41care center and can send images to doctors in minutes no matter where they are to dermatologist
19:48cecilia dietrich for example the goal is to ensure that even places with few specialists have access to
19:55preventive care around 20 percent of dermatologists in germany will retire in the next 10 years this means
20:04that in the future we'll almost certainly not only face shortages in rural areas but in urban areas as well
20:11and that's where the device or box can help to make up for supply shortfalls in a manner of speaking
20:18the checkup box is run by an artificial intelligence that compares images it takes with ones of skin
20:25cancer stored in its database marking potential problem areas for the doctor in this patient 18 so-called
20:33lesions are suspicious from home dietrich instructs the assistant to take a closer look at these
20:40areas using a special microscope that can take images from beneath the skin surface the ai is then
20:48able to calculate the probability that a lesion is cancerous it's particularly good for pigmented
20:57lesions so melanoma it's trained really well for that but there are other types of skin cancer and
21:03that's where an experienced dermatologist is better cecilia dietrich and her team are currently staffing
21:10germany's first checkup box in munich dermatologist wilhelm stolz is helping to assess the new technology
21:17according to scientific criteria he also sees its limitations with the hype surrounding ai nowadays
21:27people always imagine it can solve everything and it's true that ai provides hints but the doctor
21:33still has to decide what conclusions to draw human doctors will therefore continue to play a key role in
21:42the future when it comes to checking patients for signs of skin cancer
21:50regaining independence that's the primary goal for those who have suffered a stroke depending on
21:56its severity many patients can't lift an arm after having one or are unable to walk the brain can
22:02relearn how to control limbs through intensive physiotherapy but that's a long hard slog special
22:09prosthetics and artificial intelligence are helping make it a little easier
22:16these electrodes are designed to help a paralyzed limb work again
22:22wolfgang kohazansky suffered a brain hemorrhage several years ago and has since been unable to feel
22:28his arm in 2021 i had a brain bleed it happened at work after that i was paralyzed on one
22:36side from head to toe
22:41today we're going to fit wolfgang with these electrodes and together we'll train his hand
22:47functions with an exoskeleton and what's called functional electrical stimulation the idea is to use
22:55electrical impulses to contract his muscles from the outside so we can help patients who've lost full
23:01muscle control to perform actions like grasping and releasing things or moving their arms the round
23:10electrodes detect muscle activity while the square ones deliver electrical stimulation that activates
23:18additional muscles
23:22i'm numb on the left side i can feel a slight current now it's just been applied there's a little
23:29electricity
23:30i feel it faintly but nothing more not yet
23:36the electrode cuff transmits the measured muscle activity to a computer
23:40using ai it then guesses what movement wolfgang is trying to make and helps him complete it by
23:48sending electrical impulses to the appropriate parts of his arm first though the research team has to
23:54make sure the right electrodes are stimulating the right muscles
24:03absolutely perfect i've never had this before in the last four years this is the first time i could
24:10open it easily and then easily close it again sensational
24:17but picking up a cup is still tricky that's why an exoskeleton is added over the electrode cuff
24:25it has built-in springs that support and amplify his movements enabling larger stronger or more sweeping
24:33motions equipped with this device wolfgang can play a computer game catching a virtual
24:39ball that's flying towards him the computer detects his intended movement supports and amplifies it
24:45and also helps him execute it more easily and precisely
24:49you feel like you just want to keep going on and on because you notice the muscles are working and
24:57activated and the movements get smoother honestly it's addictive
25:03these exercises are aimed at retraining the body by re-learning movements and forming new nerve
25:10connections to reach those goals patients have to practice a lot in the future they'll be able to train at
25:17home as much as they want the more repetitions the better with a system like this patients stay motivated and
25:24do much more each day so their chances of regaining hand function increase at the end of today's robot
25:31assisted training wolfgang tries gripping the cup again the results are mixed
25:39well it was worth a try success is within reach i just have to practice that's all
25:52and that's all from us too thanks for watching and hope to see you next time on tomorrow today bye