On the occasion of European Patients' Rights Day 18. April which celebrates efforts to advance patients' rights at the global and European level we talked with Prof. Marianna Arvanitakis, the Winner of the European Award for the Best Medical Practice in the COVID-19 pandemic.

In the organization of the International Council of The Patient Ombudsman– worldwide reference network for Health Diplomacy and European Medical Association– the main association representing Medical Doctors in Europe supported the European Commission – Lifelong Learning Programme, together with the 378 colleges Prof. Arvanitakis was nominated as a winner of this prestigious award.

( Dionyssios KALAMVREZOS, Ambassador Extraordinary and Plenipotentiary and Prof. Marianna Arvanitakis)

Award Ceremony

In this difficult and unpredictable pandemic times pandemic, Prof. Arvanitakis continued to work on the most demanding medical procedures such as endoscopy, putting herself at risk when most doctors refused to work on invasive procedures. She protected especially non- covid and chronic patients. Doctor Arvanitakis’ life and career, have proven that when someone is devoted to something, with love and enthusiasm, commitment and loyalty, in her case the medicine, and the strong humanistic desire to assist others, the object of devotion becomes a part of one’s self. Devotion is loyalty to a promise, person, or mission. It means a person has to be willing to sacrifice and uphold the commitment even if the challenges are great, and all this together with extraordinary activities.

She completed her medical studies within the Université Libre de Bruxelles and her GI training in the Erasme University Hospital under the guidance of Pr Jacques Deviere and Myriam Delhaye. Her Ph.D. thesis was focused on diagnostic and therapeutic aspects of pancreatic diseases and was completed in 2007. Her clinical activity involves therapeutic endoscopy, pancreato-biliary diseases, and nutrition. She is currently a full professor of Gastroenterology at Erasme University, Bruxelles, and head of the Department of Nutrition and Pancreatology. She also is a member of numerous scientific committees including the United European Gastroenterology (UEG), the European Society Gastrointestinal Endoscopy (ESGE) and the European Society of Enteral and Parenteral Nutrition (ESPEN), the American Gastroenterology Association (AGA), and the American Society of Gastrointestinal Endoscopy (ASGE).

She has 134 publications in Pubmed with over 3600 citations and an H-index of 30. Prof. Arvanitakis knew that there is no success without hard work in the laboratory, in the library, or in front of a computer screen, perseverance in the long night hours in the hospital, passion to cure the patients, sacrifice of personal time and wishes, and respect and understanding to the people needing a helping hand.

Sometimes luck and coincidence, family tradition, play their role as driving forces that catapults our life into success, as one could say for dr Arvanitakis, whose both parents were medical doctors. But as we said before all effort needs hard work, dedication, and perseverance.
Ηighly effective medical doctors have the enormous privilege of touching and changing lives.

But why is Prof. Arvanitakis a highly effective medical doctor?

A highly effective medical doctor should have resilient professionalism under an imperative core set of values, for the care of the most fragile in society.  The best medical doctors must synthesize conflicting and incomplete information to reach a diagnosis. Deal with uncertainty as protocols are great, but doctors often must work off-protocol in the best interests of the patient. Manage risk – many patients are alive today because doctors took risks, sharing information openly and honestly with their patients. Recognize that change both in medicine and society is constant, ensuring that those standards, which are immutable, are preserved while those that are simply a product of their time are consigned to history. Be approachable, confident, decisive, intelligent, interested, compassionate, and caring – being able to absorb people’s pain and anxieties without losing focus, treating patients as human beings rather than a symptom or collection of symptoms. Their integrity is without question. Take time to listen and communicate honestly and effectively with patients, relatives, staff teams, and others whilst putting everyone at ease. Respect for everyone’s capabilities and their contribution to the team. Knowing everyone’s name in the team regardless of their position. Being fair and non-judgmental.

To have technical skills, be competent, knowledgeable, using evidence-based practice. The ability to remain calm and proficient when under pressure and still make clear and timely decisions. Be trustworthy, loyal, dedicated,  reliable, respected rather than revered, and dedicated to upholding their Hippocratic Oath. Be a visionary leader who is confident about their standards and stands firm to uphold their and the team’s values and beliefs. Prof. Arvanitakis has all the above qualities.

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INTERVIEW VIDEO

Jasminka Vugec Mihok, MPharm, University specialist of Clinical pharmacy talks with the

Prof.Marianna Arvanitakis

https://vimeo.com/698612548/c07047c26b

First of all, congratulations! It's my great honour to speak to you today. As we all know, you were awarded a prestigious prize for the best Medical Practice by the European Patient Ombudsman. Did you ever think you would be recognized this way? Did the prize surprise you?

Yes, it did because I think that many physicians, and not only physicians but also other healthcare professionals and even people who work outside the hospital setting have contributed immensely during this period. I was just another brick in the wall. This prize is very important but it’s symbolic and it represents the work of a lot of people.

You were recognized among 387 nominees, and European doctors who have made a significant contribution during the pandemic. What was the distinct contribution you were acknowledged for?

I think it was for continuing to try to offer the best possible healthcare to patients, COVID, and non-COVID patients.  For the COVID patients we’ve put in a lot of effort, which was greatly supported by the institutions, but for the non-COVID patients, it was a bit more difficult because they were not considered a priority anymore. We had to prioritize our patient care and things that we took for granted until now in our country and Western medicine all of a sudden got challenging. These were the difficulties we had, trying to continue offering good quality healthcare also to non-COVID patients.

Dealing with the lack of personal protection equipment (PPE) and possible shortages of medicines were probably among the challenges? Did you face such situations?

Yes, in the beginning, there was dealing with PPE, the masks, and then it was mostly with medication. I remember there was not enough propofol for the ICU patient, in whose care I was not directly involved, but that was one of the issues that we had. There were a lot of indirect consequences, for example in patients requiring parenteral nutrition we didn’t have any vitamins and trace elements, these preparations were difficult to obtain because of delays in production. All of these were the effects of the pandemic, and the worst is now because now we have a shortage of healthcare personnel which is now very very high because of health problems, because of burnouts, and we are now really working with up to 50% less possibility to admit patients in the hospitals. We don’t have enough beds because we don’t have enough nurses.

You've mentioned burnout. Are there any measures in place or protocols that you have in Belgium that can provide psychological support to healthcare providers?

In my hospital, there is a hotline offering at least consultancy on that, but it’s still very difficult because there are so many people that are absent, and an additional absentee is always a problem.

How do you personally deal with stress?

I try to do things that give positive energy.

What made you decide to continuously provide care even during the period many clinicians in the EU stopped working, especially when we talk about invasive procedures? Were you not afraid of contracting COVID at the beginning of the pandemic?

In the beginning, we were, but we had no choice, we had to continue. At one point we had adequate PPE to protect us, and then, after having a situation where we did a procedure with a patient that was (COVID) positive, we noticed that there was no increased risk. Finally, we realized that the risk was higher in social settings, mostly between family members, and friends, where everybody put their masks down and didn’t use any protective measures, and less in hospital settings. So, our concerns decreased. Now we have studies that show that the contamination rate within the endoscopy practice, especially if the protective measures are taken, is very low.

The insecurity and the lack of knowledge at the beginning of the pandemic was probably the biggest threat.

Yes, I agree.

You have an admirable track record of actively participating and collaborating in a range of different organizations. What is the importance of being involved in such various expert groups and how did the pandemic affect your numerous collaborations?

It is always an enriching experience to be involved in these scientific societies because of the educational value, and the networking, and it's also something different from the clinical work. So, it’s something that I really cherish. We had difficulties in continuing to organize meetings and conferences, at least in person, but that's where first the virtual, and then the hybrid modalities came, and allowed us to continue our work. This is something that gives me a lot of positive energy.

Has digitalization made these collaborations easier? Has the communication with your colleagues now changed?

I think digitalization helped in a situation in which there was no other choice. We still prefer to meet in person, and I think that when we will be able to meet in person, to organize meetings and congresses, people will prefer to go in person than to participate via a hybrid model. However, I think for the future, the hybrid model is here to stay.

What are the key leadership messages you want to get out to hospital leaders?

The key message I would like to convey is to valorize your co-workers by identifying their strong points and giving them tasks they can accomplish. Not only the overall project will advance, but each individual can develop self-confidence and further maximize their potential.

Tell us a little bit about your leadership role and how it is changing as a result of the pandemic?

As the head of the Clinical Nutrition Team, my group and myself had the challenge to deal with many patients who were extremely malnourished after a long illness due to COVID during the first wave. Despite the demanding nature of the task, this endeavour strengthened the bonds within the team, helped in finding solutions and standardising pre-existing protocols. It also boosted clinical research by involving health care professionals from all disciplines (doctors, nurses, dieticians..)

What are you looking for from your leaders?

I believe a leader should be generous, inclusive, and be able to adapt by accepting and initiating change.

What are you finding the biggest challenges?

The biggest challenge is enabling communication between members of the team, as well as between the team and other clinical or administrative structures within the hospital. Making fair choices and simultaneously protecting your team may be a difficult task.

Any particular surprises?

I was already used to working out of traditional office hours but with the pandemic we got used to longer working times, continuing during the weekends and also vacations. The “always connected“ syndrome became a way of life. Nevertheless, it is important to find ways of letting go the steam.

Are you seeing any behaviors from colleagues that encourage or inspire you?

I have the opportunity of working with many non-medical health care providers, nurses, pharmacists, dieticians…and I am always impressed not only by their accurate clinical evaluation in everyday practice but also by their enthusiasm to engage in new projects.

How are you maintaining kindness and compassion?

It is important to maintain empathy when dealing with patients; it is also the only way to sustain our own humanity as physicians. I tend to put myself in the patient’s situation and ask myself “What would I have done if this was my mother? My son? My spouse?”. This approach may lack objectivity, but helps in keeping the human factor in perspective.

Are there any ideas or readings that you find helpful, for inspiration and support, which you would recommend to others?

“ When breath becomes air” is a non-fiction autobiographical book written by neurosurgeon Dr. Paul Kalanithi, who was diagnosed with metastatic lung cancer at the end of his residency. Beyond the questions that come up regarding what makes life worth living, the book is a poignant testimony on the relationship between doctor and patient, especially when confronted to death. Reading the book helps put things in perspective, regarding our work with our patients, but also in the private sphere.

What would you recommend to your colleagues? How to implement best practices and remain patient confident in the future?

I think that working together is very important. We usually like to discuss difficult situations regarding patients in a multidisciplinary setting, so I think that's a force, to have a senior institution or to create it if you don’t have it. That really helps us in giving better patient care.

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