For EPISODE 12 of the World’s Great Doctors, it is our great honor to have Prof. Dr. med. Michael Fischereder as our distinguished guest, who is the Director of Nephrology, Medical Clinic and Polyclinic Ⅳ, LMU Klinikum.
Interests and experiences of his childhood and adolescence strengthened Prof. Fischereder’s belief and determination in being a physician and clinical scientist. As a nephrologist trained in multiple sites in both the US and Germany, Prof. Fischereder encourages young physicians to move between institutions and learn from different people to find their own interests and form their own treating concepts. As an expert in renal transplantation, Prof. Fischereder also talked to us about the challenges that German nephrologists are facing under the pandemic.
Please check the recording of the interview below
1. Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in nephrology?
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. How did your early youth experience shape your success?
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. Who have been you greatest influences? What have they taught you and how have they inspired you?
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. Based on your experience, how important is it for a medical doctor to visit different hospitals or different countries?
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. 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?
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. To a physician, how important is scientific research?
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. How do you balance your personal life, administration, clinical practice, research activities and lecturing?
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. How can a young doctor know if the hospital are giving them good training?
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. What support for young talents do you and your klinik offer? Are there mentoring programs that specifically support the next generation?
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. What advice would you give to someone hoping to start a career in nephrology?
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. You enjoy great international reputation. What is your proudest career achievement to date and why?
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. 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?
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. 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?
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. What would you have been if you had not been a medical doctor?
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. What are your hobbies outside medicine?
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.