Emiliano Vialle talks candidly to AO Spine about arriving at a personal crossroads, making tough decisions on priorities, and challenging himself not to soften up, to keeping up the hard work. We first talked during the Carnival; while others were partying, there was a rare window to catch up with the "busiest man in Latin America". And then COVID-19 happened.
How did COVID-19 affect your plans and life? Did you come to any new resolutions?
When you are a workaholic, the only way to stop is a situation like this. I have learned many things about what real medical priorities are, but mainly I have improved my quality time with my wife and kids, doing things such as playing board games, exercising, reading, a lot of cooking...
My private practice has decreased by 90%. Emergencies have kept our staff working a few times a week. By changing our department's grand round to an online platform, we were able to get participation from past fellows and residents from all over Latin America, which has also been a great experience.
Same as I always do. I even participate in the Carnival by operating trauma cases of people who party like crazy. I am pretty much the victim of our success and the past months have been more than busy. Surgery and private practice have eaten up my research time, my traveling time. We are three surgeons doing all kinds of spine surgery, more than 10 cases a week, and I do also a lot of long scoliosis surgery. My father, Luiz Vialle, is slowly reducing his schedule, and I am increasing mine.
I guess I always looked at spine surgery and orthopedics as the smart option, because my dad had already built up a practice. Medical school does pose some barriers: it doesn't matter how much you want it; you're not getting in if you're not a grade-A-student. I was always a good student, but some hard work and sacrifices were needed. I always loved sports but gave up competitive swimming.
I always looked at spine surgery and orthopedics as the smart option.
Right from the start I enjoyed being involved with trauma and in emergency rooms (ER) and I kept volunteering. It was the adrenaline, the perfect combination for me. I should maybe not say this, but I enjoyed the action of ER; it was an adventure. But not anymore so.
During my residency, others started throwing me the spine cases they could not manage. They had enough fun stuff to do with hips, knees, shoulders, and sports medicine. So, I was dealing with a lot of spine cases from early on.
Not at all, he's always been there, and we always had a great relationship. He kept pushing the bar and so far, I've been able to match up. I am one of two people who got my father timed: I could work harder than he did. All these years learning from him, working with him, arguing over new ideas and concepts has been fun. Now the roles are changing; in a few years I'll be his boss and he'll start listening to me.
The big changes happened through personal events. People I know had spinal cord injuries from trauma, which motivated me towards research and studying spinal cord injury (SCI). We set up an SCI lab in the university and for the past 20 years we have been doing basic science research, moving into stem cell research and originative therapies for SCI. I have no illusions of finding a cure for SCI, but if we can move forward and help someone in the future, it would be a success.
I guess right now I am at a crossroads whether to continue with research or not, whether to hand over the role of main researcher to someone. I am trying to establish a team and get people associated with me locally to keep local projects moving.
The big changes happened through personal events. It motivated me towards research and studying spinal cord injury.
I was invited to the AO Spine Knowledge Forum Trauma Steering Committee due to the high volume of trauma cases that we have. But I am limited in keeping up to infrastructural speed of research elsewhere. I am very conscious about what I can and cannot do regarding new outcomes in SCI. But it's something I study and read a lot on and want to contribute more to.
There are a lot of new ideas and money around in this area, not only in AO Spine, and that is exactly my point: I need a fully dedicated scientist to support the research.
What I have been doing for the past years dragged down all my time, being a surgeon, a father, a clinician, a researcher. It got to a point where I wasn't filling any of these roles properly.
Now it's decision time, it's parenting time. I understand how special this moment is, my kids will never be kids again. I enjoy doing barbecues for family meals at weekends. My short-term goal is really to improve family time and try to enjoy more of life.
Professionally, I have accomplished a lot and the challenge is to stay motivated towards research and educating surgeons, residents, and students. I guess that happens to everyone with a lot of exposure and participation from the beginning, like I did.
AO Spine was always there, and I literally saw the birth of AO Spine in Latin America. The spine specialists who would go on to foster and spread the word of AO Spine did a beautiful job. All my training was done by AO Spine surgeons. After my formal fellowship in the US, I went to Canada and the Netherlands with AO Spine traveling fellowships and returned to Brazil with a lot of new information.
What has changed dramatically, is access to information and the role of the patient.
This was the moment in history when many new technologies were introduced: osteotomies, disc replacement… and I got this from my fellowships. So, I was invited to a lot of AO Spine events and got a lot of exposure from the early days.
Most of the time AO Spine is also fun. Surgeons treat you as an equal regardless if you have major scientific publications or not. You can stand up and share your ideas and your experience with a level of equality you don't see in any other associations. You discuss cases, you're not tangled in formalities, you don't even need to wear a tie.
What I see is that the commitment to the profession is decreasing. There is a general trend that people are not prepared to work weekends or let work get in the way of their life. They are not eager to do the "super fun surgery during carnival holidays", wake up in the middle of the night and take calls that are not adequately reimbursed, like I did. I hear the next generation questioning why their professional training should affect their lifestyle at all. The "no pain, no gain" mentality is disappearing.
I do understand that there are other things in life, but I see the quality of professionals coming to the market drastically reduced. Less people are doing complicated stuff or registering for training for complex deformity cases, tumor cases, or for lengthy procedures. The gap is widening which is frightening. There are so many people who want to make a living without much effort, which may be not be the right way forward for all medical areas.
Many new technologies improve things that we already do, like robotics or navigation. Artificial intelligence is improving our diagnostic decision-making capacity. To me, the great breakthroughs lie in the information that is gathered. We might uncover new patterns that have been overlooked in the past. What limits new technologies are regulations and costs, which have held industry from fostering new research.
Especially for people in third world countries, like myself and Brazil, we see striking differences in infrastructure. I don't see my hospital using artificial intelligence, robotics, or navigation any time soon. Also, training must evolve and involve you in the development of such tools.
What has changed dramatically, is access to information and the role of the patient. Treatment decisions are challenged by patients, and surgeons have become more liable for mistakes. This should reflect in the way surgeons are trained; we must be more aware of patients' rights and hospital liabilities.
This is shifting the quality of medical practice worldwide. It is changing the way surgeons think, the way they plan treatment. If you can reduce human error with technology, you're improving quality of care and reducing liability, and that might be the way to push healthcare providers to offer better tools for hospitals.
