世界上伟大的医生(第十二期)

2022-05-20 15:58:03 广州仁医医疗 65

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本期仁医医疗特别邀请到国际著名肾脏科专家Prof. Michael Fischereder做专题访问。Prof. Fischereder现任慕尼黑大学医学院教授、慕尼黑大学医院移植中心肾脏科主任、德国内科医生专业学会(BDI)巴伐利亚分会副主席。

因为童年兴趣和中学的经历坚定了Prof. Fischereder成为医生的信念。他鼓励年轻医生多到不同医疗机构学习,找到自己的方法和研究兴趣。作为德国肾移植专家,Prof. Fischereder分享了疫情之下,德国医院肾内科遇到的挑战与应对。

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1、您是何时决定从医的呢?又为什么专攻肾内科呢?

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

我在童年时期就对科学、自然科学和生物学等非常感兴趣。当我到了该考虑职业的时候,我发现照护病人非常有意思。于是我在中学时期成为了一名救护车急救志愿者,这段经验也坚定了我成为一名医生的信念。

关于专攻肾内科那就是另一回事了。那时我在慕尼黑大学医学院上学,期间我去了美国参加选修培训课程,并有机会在一家肾移植中心学习,不仅是学习外科手术,还有肾内科的培训。那是在1986年,我遇见了我生命中第一位对我大力支持的导师Karl Nath,当时他是肾内科的主治医生。我在美国接受培训期间他非常支持我,也是他建议我成为一名肾病科医生。他为我选了一条非常适合我的道路。

Early on in childhood, I was very interested in science, natural science, biology. And when I was eventually thinking about career options, I found taking care of sick patients very interesting and wanted to learn more. And that actually is what brought me to volunteer time with a paramedic unit early on, still as a student at school, and eventually strengthened my understanding that I want to become a physician, a medical doctor.

With respect to nephrology, it was a different thing, because I went abroad to the United States for an elective training period, while still in medical school in Munich. At that time, I had the opportunity to visit a renal transplant service from either the surgical side and also the nephrology part. It was then, back in 1986, when I met my first very supportive mentor, Karl Nath, who was an attending nephrologist at that time on the consult service. He really supported me all along through my training and it was his interest to turn me into a nephrologist. And he was right. I think he made a very good suggestion for me.


2、您的早年经历如何塑造你的成就?

How did your early youth experience shape your success?

我是我们家第一个医生,我们家之前也没出过多少科学家。在我成长的过程中,陪伴我的是住在附近的朋友们,大家虽然兴趣不同,但是都非常有抱负。他们中有些人对银行业感兴趣,有些人对计算机科学感兴趣,还有些人在军队中追求理想。由于我一直都对自然科学和医学感兴趣,也因为在这样一个有抱负且雄心勃勃的环境中成长,让我从医学生一直到我成为医生都备受鼓舞。

I am the first physician in our family. And actually, there aren't too many advanced scientists in our family, either. So when I grew up, I was in an environment with many friends from the neighborhood, who all were very ambitious, but in with different interests. Some of them were interested in banking, others in computer science, and a few pursued careers in the military. And as I always had been interested in natural sciences and medicine, living in a competitive and ambitious environment was support for me also to pursue training in school and then advance to a career in medicine.


3、您职业生涯中是否有对您来说很重要的导师,他们教会您什么,是如何启发您的呢?

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

对我影响最深刻的人是我的父母和我的两位导师Karl Nath 和 Detlef Schlöndorff。我的母亲一直教导我,努力是取得成就的关键,叮嘱我教书育人对学术生涯的重要性。我的父亲是一个非常温和的人,从他身上我意识到谈判和人际交往技巧是多么重要。

我刚刚提到,在我医学生涯和肾脏学的第一个导师是Karl Nath。他是第一个认为我在肾脏病学领域有天分的人,并且支持我在此领域发展。在我留美接受内科住院医师培训的三年期间,他给予我非常大的帮助。

然后是我的导师Detlef Schlöndorff ,他把我从美国带回德国慕尼黑,并且助力我在德国的职业发展。我从Detlef Schlöndorff 身上学到最宝贵的品质:永远以数据和事实为标准,即使面对自己做出的研究或者是好朋友的研究,也要非常谨慎、富有批判精神,基于数据和事实进行求证。

My greatest influences have been my parents and my mentors Karl Nath and Detlef Schlöndorff. My mother, all along, taught me that it is crucial to work hard in order to achieve something. She always was the one who pointed out to me how important schooling in an academic career is. My father is a very gentle person who always showed me that negotiating and interpersonal skills are important, too.

My first, mentor in medicine and in nephrology, as I said early on, is Karl Nath. He really was the one who thought that I had a talent in nephrology and supported me that way. He helped me a great deal to also come to the United States and pursue a three-year clinical training there as an internal resident. From then on it was my mentor Detlef Schlöndorff who brought me back to Munich, Germany, and supported my career here in Germany.

The most important thing I learned from Detlef Schlöndorff is always to rely on data, rely on facts, and be very critical even if it comes to own research, even if it comes to research of close friends, to always, really look at the data and pursue research ideas based on facts.


4、从您自身经验出发,对于一名医生来说,到不同医院或者不同国家访问的重要性?

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

对我个人来说,到不同医院访问大有益处,我曾经在德国和美国多家医院接受过培训。不同医院的病人症状也许是相似的,但是每个医生的治疗理念都是不一样的。医疗系统的组织架构也各有不同。对于我来说,访问不同医院能让我反思不足,并且汲取不同医疗系统的优点。

我在德国上医学院时,感觉德国的医学教育偏重理论。到了美国之后,我意识到了实战训练的优势。对我来说,两种模式的结合才是最理想的方法。

当我决定专攻肾脏病学时,我的第一份正式工作是在雷根斯堡大学医院,跟随着Bernhard Krämer教授,那里是学习临床医学和临床研究的绝佳选择。当我回到慕尼黑大学医院追随我的导师 Detlef Schlöndorff时,我看到大型科研机构是如何进行基础科学并与临床和科研相结合的。

我十分鼓励年轻医生多到不同的医疗机构访学,向不同的前辈学习,我相信每个医生都会找到自己的方法,从不同的榜样身上获益。

For me, at least it was a great advantage to see different hospitals, and as you pointed out that I trained in a fair number of different hospitals, either here in Germany or the United States.

Although medical problems may be very similar, the personal attitude of treating physicians can be different and the overall organization of the medical system certainly are different. For me, this was a great way to really reflect on my training and gather different aspects of how medicine is practiced between the systems.

When I went to medical school in Germany, I felt that it was very driven by theory and learning from the books, then moving to the US I saw the advantage of very practical training. The two ways together formed, for me, the ideal approach. And likewise, when I then moved on to nephrology, my first staff position in Regensburg, with Prof. Bernhard Krämer, was a great site to learn clinical medicine and clinical research. And then moving back to my mentor Detlef Schlöndorff here in Munich was an advantage to see basic science performed in a large institution and try to combine those two.

And I can only encourage people to move between institutions and learn from different people. Every individual doctor will find his or her own way how to personally profit from different role models.


5、作为多个肾脏病学相关科学学会的活跃成员,您认为这些学会对学科和医生有何重要意义?

As an active member of multiple societies of nephrology, how important do you think these societies are to the field of nephrology and to the physicians?

在我看来这些学会为大家提供了非常多组织良好的教育活动,这也是我加入学会的价值所在。跟热门学科如肿瘤学相比,肾脏病学是比较小众的学科,同一时间没有太多的科研项目。但是我认为一个能够帮助肾内科医生关注最新进展的学会是非常有益处的。与此同时,这些学会为新手肾脏病学医生提供特别的培训项目引导他们入门,这也是非常好的。

In my understanding, these societies offer a very good opportunity to organize structured educational activities. This is really, for me, the most added value from being in these societies. Even in a small field like nephrology with not so many research projects being done at the same time compared to fields like oncology, still, I find it helpful to have a society that helps all physicians in the field to focus on the most recent advances in the field. At the same time, these societies offer early-on support for novices in the field in order to get them introduced by special mentoring programs, which I find very fortunate.


6、您认为科研对一个临床医生有何重要意义?

To a physician, how important is scientific research?

我认为科研是每个医生行医的基础,即使是不太积极参与科研的医生,了解如何进行科学研究、如何整理科研成果对他们来说依然至关重要。因为治疗患者应该始终以坚实的科学事实为基础。当然,成为一名好的医生还需要良好的人际沟通技巧,但是科学事实是不可或缺的。

作为一名临床研究人员,我发现把成果转化到病人照护上的临床研究也是非常重要的。一名好的医生必须要有理解科研成果的能力,并不是说每个医生都得亲自做科研项目,但是所有的治疗方案都应建立在科学数据和科研成果的基础上。

I think scientific research is the basis for every physician, even for those who are not actively involved in research. Still, it is crucial that they understand how research is done and how research is reported. Because treating patients should always be driven by solid basic scientific facts. Of course, it takes other skills in interpersonal communication. But the scientific basis is crucial. 

And as I am a clinical researcher, I find, also, clinical research that can really be then translated into patient care important. In order to practice medicine, one has to be able to understand the results of research projects. Not necessarily every physician has to perform his or her own research. Every treatment should be driven by scientific data and based on solid research.


7、您如何平衡行政、临床、科研、教学工作及个人生活?

How do you balance your personal life, administration, clinical practice, research activities and lecturing?

这是一个非常难的问题,因为有时(时间安排)会有冲突。对于我来说,作为一名临床医生,我大部分的注意力都放在病人身上,我认为专注于照护病人是我的义务。除此之外,行政工作也是必要的,否则我的科室无法运转。

科研和教学是抽空进行的,教学的时间一般是根据学生课表而定,而科研的时间安排更有弹性。除去这些活动,剩下的时间就是留给个人生活的。有时我感觉我留给个人生活的时间实在是太少了。但是没办法,这是我的职业决定的。我学医的第一天起就意识到这一点了。所以假如一个人比较注重个人生活,那我不建议他选择学术或科研道路。

This is a very difficult question because sometimes there are collisions. For me, as a physician involved with patient care, my patients often, if not to say, always have the first right to get my attention. I always feel obliged to really focus on treating my patients. Beyond that, certainly, administrative tasks are necessary in order to keep the department running.

Research is something along, like lecturing that can be done if you schedule your day, and then you can find the appropriate time slots. While lecturing is more or less given on the schedule for the students. Research projects, depending on the nature, have more flexibility. Well, now you see, adding up the last that's left is private life and sometimes I feel there's a little bit too little time for private life, but that comes along with the career. This is something I’ve known from day one. So if one rather has a focus on private life, pursuing an academic career and research might not be the way to recommend.


8、年轻医生们如何知道医院是否正在对他们进行良好的培训?

How can a young doctor know if the hospital are giving them good training?

德国规定年轻医生每年至少要与培训负责人进行一次年度会谈,这样他们可以根据现状适时调整培训计划。

对于我的住院医生来说,我认为在非正式情况下跟我讨论培训进度更重要,这样他们可以及时告诉我他们在培训中最想学到的东西。同样,我也可以实时把握他们的进度,并给他们合适的建议。

医学生的培训包括掌握各种技能、接触不同病人,并在不同科室之间轮转。年轻医生应该尽早意识到,如果他们有机会去轮转,他们会看到其他医疗机构的进修医生和楷模医生的培训是如何进行的。如果你没有去不同科室、不同领域轮转的机会,你应该尽快跟你的科室主任反映。

In Germany, it is mandatory to have at least an annual talk with the person responsible for the training. So that young doctors can readjust their plans based on what they've been experiencing so far. For my residents, I think it is more important to get in touch with me on short notice to talk to me without a formal scenario as well, so they can tell me what they pursue as most important for their training. Likewise, I see how they are doing, and I recommend to them how to continue with their training.

Training in medicine involves certain skills and exposure to different patients and rotations through different departments. And I think young doctors should early on realize if they have the opportunity to rotate, they can see from other more advanced doctors and their role models how training is happening at a certain institution. And if no such rotation through different departments, through different areas of procedures happens, this is something that should be brought up in a discussion with the department head early on.


9、您和您的科室为年轻人才提供了哪些支持?是否有专门培养下一代的指导计划?

What support for young talents do you and your klinik offer? Are there mentoring programs that specifically support the next generation?

慕尼黑大学医学院有这类项目,我们会根据科研项目的先进程度,保障年轻人才的科研时间和资金。这个项目叫 FöFoLe,致力于支持年轻的研究人员。在我们肾内科也有类似的计划,保障年轻人才在轮转过程中的研究时间,让年轻医生有更多可支配的时间。同时也鼓励他们到其他机构进行研究和轮转。但这因人而异而且取决于经费,所需经费不能超出科室或大学给的范围。年轻医生还可以通过德国自然科学基金会(DFG)申请科研资金,我们提供其他方面的支持。

For our department at the Ludwig Maximilian University, we do have mentoring programs that support a protected time for research, depending on the stage of how far advanced the research program is. That’s called FöFoLe, which supports early on research. The other support specifically we in nephrology give to young talents a more protected time through rotations in either not so demanding rotations, which gives the doctors a little bit free time. And also the support to go for research, and rotations elsewhere. But that is on an individual basis and depends on grants, which are then not out of the department or the university. But the German research foundation, the DFG always offers research grants that can be applied for, and then we support them.


10、对于想要从事肾内科的年轻医生/医学生,您有什么建议?

What advice would you give to someone hoping to start a career in nephrology?

我会建议先了解清楚肾内科的日常临床工作,临床情况不同会存在很多差异。肾内科的门诊服务包括一周六天的肾透析。意味着一周当中有六天需要为病人提供服务,如果你想把这当成终生职业,需要好好考虑这一点。如果选择学术型道路,我会建议年轻医生开拓自己的眼界和想法,目前还有很多悬而未决的问题都很值得我们研究。

我认为每个对肾脏病学感兴趣的人都应该了解一下这些开放性问题,找到自己最感兴趣的研究兴趣,然后寻找一个专门从事这方面研究的机构。

I would recommend really taking a close look at how nephrology is practiced. There is quite a diversity depending on clinical settings. Ambulatory or nephrology in just outpatient practice involves dialysis, which is a 6-day week. You always have to treat patients 6 days a week which really is an important fact to take into account for a lifelong career. If looking at scientific nephrology, I think one should look at the different aspects - there are so many open questions that still deserve research.

And I think every person interested in nephrology should look at these open questions and see which specific research interest is important to her or to him, and then find an institution where particularly that research can be pursued.


11、您在国际上知名度很高,至今您最自豪的职业成就是什么,为什么?

You enjoy great international reputation. What is your proudest career achievement to date and why?

大约15年前,我申请了美国密歇根大学医疗中心肾脏移植中心主任一职。在众多竞聘者中,我收到了聘书,但我最终没有接受。不过我很自豪能够被密歇根大学这样的知名机构认可,得到肾脏移植中心主任这个竞争激烈的职位。

Well, about 15 years back, I applied for a position at the University of Michigan Ann Arbor Medical Center as a transplant director. And actually among many competitors, I was offered the position which eventually I didn't take. But it made me very proud to be recognized by such a prestigious institution as the University of Michigan Ann Arbor for such a highly competitive position as a director in clinical renal transplantation.


12、在中国一些地区许多病人因为严格的疫情管控措施无法及时进行治疗,比如肾透析、肾移植等。对于这种情况德国是如何解决的?

China is now facing another wave of pandemic. Many patients are not able to receive proper treatment like dialysis or renal transplantation in due time due to the strict COVID-regulations. How is this dilemma be addressed in Germany?

在第一轮疫情时,我们推迟了活体移植项目。因为当时我们误以为只要疫情结束,随时都能进行活体移植。

但是现在我们看到疫情还在持续,推迟任何手术都不是如此简单的事,即使是活体捐赠。所以现在我们所有移植手术都照常运行。至于遗体捐献项目我们从来没有推迟过,因为遗体器官捐献对手术时间有非常严格的要求。

从第一轮疫情我们意识到,即使是活体捐赠项目,延迟也是不可行的。所以从第二轮疫情起我们不再延迟移植手术。术前我们会确认捐献者和受捐人都已接种新冠疫苗,并让他们签署知情同意书,了解术中的感染风险。对于透析患者来说,我们认为尽早接受移植手术后可以安心居家,比每周进行三次透析更好,后者一定程度上有感染新冠或其他病原体的风险。

Early on in the first wave, we postponed our living donation transplant program. because we felt that this could be done any time after the COVID pandemic. Now we see that the pandemic is going on and it's not so easy to postpone surgery even projects such as living related donation.

So now we continue with transplant surgery. We have never stopped the deceased donor program, because you take the kidney or if you don't take it, you will have to bury it with the donors. We learned from the first wave that if you're trying to postpone procedures such as living related donation, it does not work well.

So ever since the second wave and from then on, we have been continuing with our transplant programs. We make sure our donors and recipients are vaccinated. We get informed consent that they all understand the small but real risk of contracting infection. Yet we feel that especially for dialysis patients, having a transplant and being able to stay at home is an advantage compared to having to come to a dialysis unit 3 times a week, which goes along with a certain risk of infection with COVID and other agents.


13、新冠肺炎疫情现在是医疗领域最大挑战之一,您认为这对您所在领域有何影响?

The COVID-19 pandemic is one of the biggest challenges facing modern healthcare. What impact do you see this having on the field of nephrology?

新冠疫情让我们意识到我们必须保护患者免受感染,以及这在肾内科有多困难。一周要进行三次透析的病人每周都会在感染风险中暴露三次。如果透析室有疫情爆发将会是非常严重的问题。这也是当前大多数肾内科医生面对的主要问题。

另一方面,正如我们刚刚讨论过的一样,我们意识到即使有新冠疫情,我们的治疗都必须要继续,比如透析、移植及肾病诊断等。

与其他择期手术(如泌尿外科、骨科、眼科等)不同,肾内科的治疗无法延期,这都是维系病人生命的必要条件。这一点对之前没有意识到持续提供肾脏病治疗重要性的同事们来说尤其明显。所以我认为疫情也让大家意识到肾内科的重要性。

COVID-19, made us realize how much we have to protect our patients from infections and how difficult that can be in renal units. Patients that have to come to dialysis 3 times a week are potentially exposed 3 times a week. If you have an outbreak of COVID in a dialysis unit, this is certainly a concern. This is a major practical problem that many nephrologists are dealing with these days.

On the other hand, as discussed earlier, we realized that treatment such as dialysis and transplantation and diagnosis of renal disease has to be continued despite the COVID pandemic. Unlike other fields as elective surgery in the urology, orthopedics, ophthalmology, treatment in nephrology must not be postponed, which is early on life-sustaining. And this is something that became very obvious to many colleagues who have not realized how crucial a constant availability of nephrology treatment is. So I think it helped the field to gain visibility with respect to the importance of nephrology.


14、假如您不从医的话,您会从事什么行业?

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

因为我一直以来都对科学和生物学非常感兴趣,我可能会想成为一名生物学家。随着生物学的发展,我发现分子生物学也非常有意思。我不确定我会不会成为一名分子生物学家或从事其他领域,但是科学一定会是我职业生涯的重点。

Because I always found science very interesting and also found biology very interesting, I probably would have been a biologist. And now with the many advances in biology, I find molecular biology very interesting, but I'm not sure if I would have been a molecular biologist or in some other field, but science certainly would have been the focus of my professional life. 


15、除了医学外,您还有什么兴趣爱好?

What are your hobbies outside medicine?

根据不同季节我喜欢做不同的休闲运动,平时我喜欢跟高中时代的朋友们一起打壁球。到了相应的季节,滑雪也是非常美妙的运动,尤其是我所在的慕尼黑就在阿尔卑斯山脚下。如果我出国的话,我也偶尔玩一下水肺潜水。运动之余,我也喜欢欣赏表演艺术,我偶尔会看歌剧或者芭蕾舞表演,这些都是我在疫情封城期间错过的事情。除此之外,我也喜欢去画廊看艺术品,虽然我不是艺术方面的专家。

There are a few recreational sports independent of the season. I like to play squash with friends back from high school. And then depending on the season, skiing is a wonderful sport, especially here in Munich with the Alps so close by. And I also enjoy scuba diving once in a while if I go abroad.

Outside sports, I love performing arts, and I go to the opera or watch a ballet once in a while. And this is certainly something I missed during the lockdown. Aside from that, I enjoy going to galleries and looking at artwork, although I would not call myself an expert on arts.

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