Rozhovor s MUDr. Šimkovou ako členkou vedeckého tímu WONCA Europe Conference v Bratislave.
for the Host Organizing Committee
MUDr. Adriana Šimková, PhD.
member of the Host Organizing Committee
In 2018, you received the “Science and Technology Award” in the category of the “Science and Technology Personality” which is the highest award of the Ministry of Education, Science, Research and Sport of the Slovak Republic, for your contribution to the identification of asymptomatic patients at higher risk of cardiovascular diseases aimed at preventing their complications. Why is research and the sharing of research results important for a GP too?
The research in the primary care area is of a particular nature. Daily, a GP sees a number of patients presenting a variety of clinical conditions. It is this clinical diversity that requires the use of relatively simple methods which facilitate the diagnostics and the treatment by the physician. This is just one of the reasons why the research conducted at a higher level or in the laboratory is inherently different.
In Slovakia, the research in general medicine starts developing slowly. We appreciate the opportunity to collaborate with specialists. On the other hand, they learn about the problems of scientific research in the office of a GP. The collaboration has the positive effect of deepening the relations between the two sides.
Why is the research important? The research enhances the work of the physician. In particular, I can see benefits from the professional point of view, such as thinking in a broader context, improving communication skills and establishing new contacts. Through research, the physicians gain skills to be used both in their practice but also for the sake of the academic community.
I know from my own experience (and I will no doubt share the opinion of my colleagues) that combining research with an established clinical practice and family life is very difficult. This means evenings and weekends spent studying and researching literature, writing scientific articles, papers…Indeed, this calls for the support of the family and compromises.
Your office is situated in a small town in western Slovakia. Nevertheless, you do not miss any opportunity to take part in a variety of scientific events, both with local and foreign colleagues. How do you succeed in integrating the knowledge gained through these encounters into your office practice?
I appreciate the paper presentations by my colleagues. I am grateful when I learn something new or when I get a confirmation that the procedures that I learnt are still valid. Useless to say that a physician can never stop learning. I am not afraid to integrate new knowledge into practice. I know it brings about an improvement of the quality of patient care. And this is my aim.
On the other hand, if in the office I come across a “problem”, I look for answers not only in local but also in foreign scientific literature. I prepare a presentation and I go out to meet my colleagues with a summary of recommendations. I want to share the knowledge that I have gained and make their work easier. This also explains the reason of my “scientific work” – I search for answers to my questions and then share the knowledge.
Slovak patients now also have the option to share their reviews anonymously on the Internet. Your practice has received only positive reviews. Why is the feedback from patients important for each physician and how can it affect the quality of the work in the office?
The feedback from the patients is only one of the options how a physician can monitor the satisfaction of the patients. I have prepared a satisfaction questionnaire myself and left it in the waiting room. Anonymously, the patients wrote what they would like to change, improve or what they missed. In this way, I have involved them in improving the office. By combining my ideas and the patient proposals, we have jointly developed the current profile of our family doctor´s office. Each doctor is pleased when a patient publicly thanks them. We live at a time when praise becomes increasingly rare. Unfortunately, we are literally poisoned by negative news which may not be based on truth. When a positive review appears, it is all the more valuable.
When assessing the work of your office, in addition to an outstandingly helpful approach of the physician, the patients also appreciate the human approach and professionalism of the nurses. Does this show that human approach on the part of health professionals is an important part of the “treatment” of the patient itself?
Absolutely! When entering the office, the patient most often meets the nurse. Her behaviour, communication, mood and professional approach can significantly contribute to a pleasant working atmosphere in the office. She can eliminate the concerns and anxiety of the patient and the patient begins to “heal” right from the start, even before being examined by the doctor. A friendly attitude and kind words can sometimes work wonders.
How do you try to improve your office management so that the patient can benefit from it? (Nurses, instrumentation, a system that prevents long waiting times)
I lay an emphasis on high-quality technical equipment and on the staff. In the waiting room, I have a modern patient queuing system. There are several POCT devices for rapid diagnostics in the office. Visits by appointments are also possible. Of course, patients receive phone calls inviting them to come for a preventive health check-up. Patients can also communicate by email. We have introduced several options for planned prescriptions so that the waiting times are as short as possible or none at all. We provide services which allow reducing the numbers of referrals to specialists. We also provide other practical services. Now, I consider hiring a third nurse.
Nowadays, if GPs want to achieve more than just the recovery of the patient, they must do much more than can be seen by the patients. Is it important that patients know what the work of a GP in the office involves?
We have recently discussed this issue with my nurse. The months of January and February (during a flue epidemic) this year only confirmed our conclusion. If it were possible, we would happily work behind a glass doors so that the patients could see how the work in an office is carried out when they sit in the waiting room and complain about what takes us so long. Sometimes, however, they are surprised when they come in and see what is going on there. They say: “Now we understand”. Two nurses and sometimes even two doctors are busy with work. Intravenous drips and injections are applied, prescriptions are made and, at the same time, the phones ring. Work with the “real patient” is only a part of regular practice. The rest is administration (completing diagnosis reports for the social security, office of labour, social affairs and family, various documents for private insurance companies, applications for spa cures, communication with health insurance companies, etc.). If doctors communicate with patients through e-mail, they must also take time to reply. This is without mentioning patients who, for some reason, do not know how or cannot come to the office for an examination. Then the doctor sees the patient at home. I cannot forget educational activities which are a condition for continuing to work as a physician. It happens that I sit down to do the “paper work” in the evening when others e.g. watch the TV.
What, based on your experience, would significantly improve the functioning of GP offices in Slovakia for the benefit of the patient?
At present, having more general practitioners is probably an illusion. It will take some time until Slovakia manages to address the shortage of general practitioners. Less administration and cancelling some nonsensical prescription limitations would help certainly. For the time being, at least funds should be made available to GP offices. The GP could then afford to hire another nurse, an office worker or purchase new diagnostic equipment. Surely this would bring about an increase in work efficiency which will be felt in particular by the patient.
On the other hand, the patients themselves can also contribute to the improvement of the functioning of the office by a responsible approach to their health. In addition to the principles of a healthy lifestyle, this also includes regular preventive checkups to identify risk factors. If the treatment starts earlier, clinical complications that require frequent visits to primary and specialised offices, as well as to advanced inpatient facilities can be avoided.
Making a number of educational videos on the most common diseases which the patients come to see a primary care physician about (respiratory diseases, back pain, urinary tract infections, etc.) would be a very good tool. The patient would thus receive instructions on how to proceed in a particular condition. Slovakia ranks among countries with the highest number of visits to the GP, thus this form of education would be helpful in directing patients who really need to see a doctor to their GP.
What does the human aspect of medicine mean to you personally?
To me personally, it is about the art of listening and, to a certain extent, about patience. Furthermore, about clearly explaining the diagnostics and treatment. Together with the patient, I weigh all available alternatives. It is about the art to treat while keeping in mind the quality of life. Simply, it means that if, several years later, I return to my decision on a particular patient, I can say with a clear conscience that I have done everything in my power and, at the given moment, that was the best decision.
In October 2017, as a feedback from my patients, I received an official letter thanking me for my care and a highly professional and human approach. “We thank you for exercising your profession with love,” read the last sentence in the letter. To me, this letter was a confirmation that I have taken the right path, the path towards the patient.