EPISODE NINE｜The World’s Great Doctors with Prof. Christian Stief

Prof. Dr. med. Christian Stief 

One of the world’s foremost urologists, Prof. Christian Stief talks to Gloryren about his illustrious career. Prof. Stief, who serves as a member of German National Academy of Sciences Leopoldina, the Deputy Medical Director of the University Hospital of Munich, Professor, and Chairman of the Dept. of Urology at the Ludwig Maximilians University of Munich, reflects on his inspiring youth, the importance of international exchanges and scientific research for a medical doctor.

1. Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in Urology?

I come from a pretty old family of medical doctors. Already my grand-grandfather has been a doctor. And almost all these people, my grandfather, my grand-grandfather, they all have been doctors and they all have been surgeons, not really surgeons, but gynecologists. But at that time, usually people were at the same time both general surgeons and gynecologists.

And I even haven't thought about it, but for me, it was all-natural that I should at least consider becoming a medical doctor. And I was lucky to be accepted into the university. Later on, I really had lots of fun in the study to become a doctor, because at least the study for medicine here in Europe is so broad that I can learn a lot of things that are useful for daily life. So I was first positive to go into medicine. I was fortunate to get a place over there. And I had lots of fun studying medicine.

I changed universities many times. I started in the countryside, what is called Homburg at the French border. Then I studied in Freiburg, which is a very lovely, smaller, classical European student town. Then I went to Africa, to Botswana. Then I went back to Freiburg, and from Freiburg, I went to France and studied my last year in France at Montpellier.

And then you ask me: “why did you become a urologist?” I have to admit that this has been a pure coincidence. I, as my people before me, obviously wanted to become a gynecologist. But in Germany, at that time, after I finished my university studies, I had to go to the military for 15 months, what we call is “being drafted”, which means it's mandatory that anybody had to go to the military. And since I finished my medical studies, they offered me a job in a military hospital for 15 months. And I didn't really have the chance (to choose). They just put me into the department of urology. And then I have to admit, I liked the job a lot, I liked the surgery a lot, I liked the patients a lot. And then I stood in urology.

2. How did your early youth experience shape your success?

I come from the countryside, from a small town, not from a big city. And I have been brought up, let's say, in very safe ways. It means that it's a small town where the crime did not exist, where there were no drugs, there were no bad influences. So I had a pretty lucky youth. I was brought up by parents who really love me.So the circumstances were pretty good and what you learn in the countryside when you have a reasonable childhood and grow up in safe circumstances, is to work reasonably hard. Still, you can enjoy life, but you can make succeed just by working hard, trying to get good grades in school, and just trying to do a reasonable job.

And besides this, I learned that, besides working hard at school, it's important to have spare time besides the time in school. Because the capabilities, the things you learn outside the school horizon are very important. Like, if you live in the countryside and you organize yourself in smaller groups, whatever, in our society, it's often the church, or it's often charity organizations, you learn a lot, you learn to cope with others. If you then grow older, you learn to take over responsibilities, even lead a smaller group and then lead broader groups. So you learn how to manage groups of people, how to have a reasonable influence, how to have a positive influence on people, how to manage things without putting pressure but in convincing people. And I think this you learn very, very early on in your childhood and adolescence.

But when I was an adolescent like 15, 16, 17 years of age, I started playing music in a rock band. And even that has been very inspiring. You learn an instrument, you learn to sing, you learn to do music with others together. And by playing music, you learn many different things that you would not learn in school. I think you learn a lot of social skills, too. So my advice for young people is to do things outside the regular school schedule, to learn things that may not have a specific purpose at the moment, but will help you a lot during the course of your life.

3. Who have been you greatest influences? What have they taught you and how have they inspired you?

When it comes to the greatest influence of my life, obviously, it's the parents, but maybe for my professional development, it was my uncle, the brother of my mother. At that time, 30 or even 40 years ago, he has been the most influential gynecologist in the country. He has been a very modest man, but a very influential, very good, and extremely skilled surgeon. He kind of took me by the hand, and introduced me very early to surgery, to patient care, to how you learn a lot, how you can see things, how you can possibly best treat patients, what are strategies to help people even beyond their immediate disease. Like, are there psychosocial aspects? Do you have to talk to relatives and not just treat the disease? That has been a very strong influence and a very big help. And he always supported me when I had ideas like going abroad, going to a different university, visiting different clinics, visiting different hospitals, going to the U.S. doing research over there...

I think you benefit largely when you have a mentor. It does not have to be a family member. But it's very helpful if you have somebody who takes care of you, not for their own interest, but who helps you during different steps during your life and during your career.

4. Based on your experience, how important is it for a medical doctor to visit different hospitals or different countries?

I really think it is of paramount importance and of utmost importance. The thing is, if you go to different places, if you go to different countries, you can see, you can feel, you can experience that the same disease that the same problem can be solved by different approaches. And you can see that there are many ways leading to one solution or to one good solution. The important thing is that your mind becomes broader, and you become more open to different solutions to one specific problem.

If you grow up just in one hospital, you always do the same thing. Your boss always tells you to use the same approach, and you always solve the problem in one and the same manner.If you go to different places, you see that you can solve it in different manners. Probably, and most likely, you can see and you can learn that other solutions are at least equally as good or maybe even better.So going to different places, visiting different countries broadens your horizon and I'm absolutely convinced that it makes you a better doctor and a better person.

To put things straight, we have the system in my country that if you have open positions, people can apply from all over the world. So we don't have a national distribution pattern, like in the US or like in France, or in Italy. In my country in Germany, you can write a letter to a chairperson and tell the people that you would like to apply for a job. So the system is very flexible, is very competitive. And we would never ever hire a young doctor who has not been abroad, at least for half a year or better a year.

In Europe, it is extremely easy to go to different countries and to study in different countries. We do have a program that is called Erasmus, which allows every European student to study abroad during university studies, and it is even financed by the European Union. So nowadays, it's very easy (to go abroad). At least in my understanding, if you wanna work at a good place, if you wanna really add something as a young doctor, you must have benefited from that program and visit different places to see different things.

5. Congratulations on taking the position as the Deputy Medical Director of LMU hospital. Could you please share with us your plan on this position for the following years?

Thank you so much for your congratulations. Just to put things straight, becoming a deputy medical director here at the LMU is a lot of work. And the fun is that it is not paid, which means it is an extra time that you really devote to the common benefit.

I really try to do a very modest life, which means my job as the Deputy Medical Director is not affecting the strategy where we wanna be in the next 10 years. My position is more or less the the emergency call for the other Directors or the other professors who usually cannot reach the board of the hospital. It's very difficult to reach other board members than myself. So if other professors or Chair people have a problem, they take their phone to call Chris Stief. And they ask me to help them with their problems.

Like, at the moment, we have a big big problem with Covid-19 over here. To give you an idea, on normal days as a department of urology we have about 103 beds. And at the moment we have about 60, so at least 1/3 of the capacity of our hospital is in taking care of Covid patients, both intubated and non intubated. So it's a big big thing here in our health care system. And I try to help people solve problems so that they can take care both of their so-called normal patients and of their Covid patients. So to summarize, I see my job as Deputy Medical Director to solve daily or weekly or, let's say, monthly problems and maybe yearly problems, but not the strategy for the next 10 years.

6. What about your personal plan?

My personal plan is very simple. We have become, let's say, one of the real big departments of urology worldwide. And at least there are several systems that you can look at the quality of the medical care and of the surgery you provide to the patients because we have nationwide surveys. And these surveys cannot be influenced. During the last years, we were even the leader in medical quality in urology, in our country. So my strategy for the next years would be that we try anything to keep the high patient numbers and that we try definitely anything to provide the high-quality care of care that we provide to the patient, both in surgery and in conservative medicine. That is of paramount importance that the patient care we provide should be the best possible. I won’t say on earth, but at least in my country, that is what drives me.

7. How do you balance the personal life, administration, clinical practice, research activities and lecturing?

That is a very, very terrible question. The question is so terrible because there is, obviously a huge discrepancy between my private life and professional life. And I really have to admit that I kind of dedicate my lifetime, at least the last 35 years to the job and not to private matters.

Since I was 24, I work about 14 hours a day. And I usually work long hours on the weekend. During the week, I devote almost all my time to patient care. And over the weekend, I structure research, which means at my position, even if  I am very motivated, I cannot do the research myself. The only thing is that I can facilitate research for the young ones. I can try to provide money for the young ones. I can try to provide lab space. I can try to find interesting projects. Thus my job is to structure the research, but I cannot do the research myself. Usually, I do administration and research activities over the weekend or in the evening between 9 and 11.

8. You have been an active member of many leading organizations or societies in the field of urology. How important do you think these societies are to the field of urology and to the urologists?

My lifetime experience is that basically good patient care is the aim of our job. And good or even excellent patient care is only possible if you have a free exchange of ideas, of concepts, of projects, of research activities, with other ones, and the best is the case where you have a free exchange of ideas, of science and knowledge with as many international colleagues as possible.

This is usually done on big international meetings like the American or the European urological meetings where about 15,000 to 20,000 specialists come from all over the world, where you discuss very openly and very freely what ongoing problems are, what ongoing ideas are, and what ongoing concepts to solve these problems are. International meetings and international exchange are all about the big picture and are really advancing the field.

On the other hand, there are so-called national or local meetings. These national and local meetings also have very important features. The office-based urologists, who work in the city and take care of daily patients, go to national and to local meetings and learn what is up to date in the year 2021 or next year 2022. They don't care so much about what will be the future in 5 years, which will be discussed in international meetings. These national meetings focus more on what the treatment for today is up to. And that's the role of local and national meetings.

To summarize, there are two entirely different levels of international meetings and of international societies. There are really the big international meetings. We go there to have an idea of where the development of diagnostic and therapeutic procedures is, where the strategy in 5 years will be. And then, on the other hand, there are local and national meetings where we go to see what the treatment of, let's say, prostate cancer or incontinence nowadays is. And big international meetings definitely help to advance the science, to advance patient care. But that really is for the ones what deeply involved in the field.

9. You are the surgeon operates most major urological cancer operations per year in German-speaking countries and at the same time scientifically active as a member of German National Academy of Sciences Leopoldina. How important do you think scientific research is to the clinical doctors?

Scientific research, both clinical and preclinical, is of paramount importance for the development of every specialty in medicine. As a doctor, especially as a surgeon, you do your daily job based on the experience of the past and maybe on the experience of today. But when it comes to treatment strategies to diagnostic approaches for the patients for tomorrow, for next year, or for 10 years, you have to be engaged in research.You have to see what the underlying mechanisms of disease are on a cellular level, on a sub-cellular level, on a tissue level, to think about what may be the next step in diagnostics for a specific disease. And obviously, as the next step, if you understand what may be the next diagnostic, you may think about what may be the next therapeutic approach for better patient treatment.

So, in daily clinical practice, experience from the past and today is sufficient. But when you think about treating patients tomorrow and next years or 10 years, you definitely have to be engaged in scientific research to see what comes next for our patient and how can I help, how can we help, how can the department help, how can the hospital help in achieving that goal.

10. What is your proudest career achievement to date and why?

That's very simple and very easy. The proudest achievement of my scientific career is becoming a member of the Leopoldina, which is our National Academy of Science. It is the oldest scientific academy still existing worldwide, with about 1,500 active members in Germany, Austria, and Switzerland. Plus, it has about, I think, 30% of international members. It holds hundreds of Nobel laureates. So, it really is very, very selective.

And what is very nice for me is that I am the only and first urologist that has become a member over there. There has never been a urologist at the Leopoldina. And at the moment, I'm the only one. So that's a pretty cool thing.

And just to give you an idea, at the moment, the adviser who advises the German government on how to cope with Covid-19 is the Leopoldina. So, if our government has a scientific problem or a problem that needs scientific advice, they ask Leopoldina. So being a member of Leopoldina is both very cool and very influential because you have direct access to high politics.

11. How much do you know about the Chinese researchers ?

I really think the world and the scientific world owe a lot to Chinese researchers. Like, I'm not involved in Covid-19, but as far as I know, it has been a Chinese researcher from Shanghai who first published the genome of the virus, which allowed to develop the tests, to develop the treatment strategies.

I think it's very, very important that the Chinese researchers become or stay part of the worldwide scientific bodies, that we have open access, free exchange. There are so many smart and extremely well-trained and extremely intelligent researchers and medical doctors in China that we definitely need a friendly tone, a daily discussion, and an open exchange of data and projects with them.

We are fortunate and very proud that we have two big scientific projects with Chinese researchers from a university in Guangzhou. We have one on bladder cancer and another big one on benign prostatic hyperplasia sponsored by the Chinese government at the moment.

12. What advice would you give to someone hoping to start a career in urology?

I think these are general advice you give to your kids, to young pupils, to young students. First, work hard. Second, stay open, stay curious. The third one would be to go to different places, go to different countries. Fourth, if you don't work hard, party hard, which means to enjoy life after you have worked hard, I think that's very important. And the fifth suggestion would be if you become successful, be very modest, the more successful you become, the more modest you should become.

13. What would you have been if you had not been a medical doctor?

That's a very difficult question because all my life I thought I would become a medical doctor. I think I would have become an economist.

14. What are your hobbies outside medicine?

My hobby is playing tennis. I hike a bit. I read a lot. And I like fine arts. When I studied medicine, I studied fine arts in parallel. What I like a lot is European art between the 11th and the 14th century, what we call Roman and Gothic Art. I like that a lot. So I go to exhibitions, I fly to all churches, I look at all paintings. My house is filled with art. I like it a lot, I read a lot and I learn a lot. I really enjoy this.

Prof. Stief’s team is now open for application from China for an M.D. degree in Urology. The qualified candidate could get a degree of Doctor of Medicine from the Ludwig Maximilian University of Munich after finishing a 2-year full-time study.