Credits for empathy

Libor Mysliveček, student. Many Czech doctors study in this country but then “escape” to another country where the working conditions are better. Libor Mysliveček (24) plans to do the reverse. After he graduates in general medicine from the University of Bristol in England, he wants to come back to the Czech Republic. Why? And are there any differences between healthcare and patients here and in the UK?

Why did you decide to go to the UK to study medicine?
I’d learned very good English at the Open Gate Grammar School in Babice, and I wanted to use it. I’d also noticed that friends who’d spent some time abroad came back with a slightly different attitude than people who hadn’t travelled much and had stayed here. I thought getting to know another culture and studying in another country would be a good combination. I also wanted to work on research, and universities in the UK are very flexible in that regard, with lots of opportunities to work with research teams.

Why did you choose medicine?
I was unlucky with my science teachers at primary school, and I never liked biology – in the sixth grade I almost failed it, and I was sure I’d never do medicine. But then I went to Open Gate, where there was a brilliant teacher, Kateřina Kožnarová, who gave me a completely different perspective on biology. I found I was fascinated by the details of how the human body works. I was interested in all the things that could go wrong, and how to fix them. So initially my motivation wasn’t that I wanted to cure people, but I wanted to find out more about the different processes in the human body, and medicine was the logical outcome.

How did your teacher manage to get you interested in biology?
She was really passionate about her subject. The individual topics – we started with plants and went on to more complex organisms – weren’t actually that interesting. But when Mrs Kožnarová was teaching, all of a sudden they weren’t the boring lessons I remembered from before. I started studying biology at home in my free time, and it ended up being one of my favourite subjects.

Czech patients often complain about consultants, especially their impersonal approach. Is that a problem with British consultants as well?
I haven’t witnessed that. In paediatric cardiology, which is what I’m interested in, they make sure the children’s parents understand everything their children are going through. And they also have simplified consultations for the children themselves. Keeping patients properly informed and giving them autonomy matters a lot in the UK, and the importance of doing so is stressed to young medical students.

Patients often tell their doctors about things they’ve seen in the media – mostly about new research and options for treatment, and they ask if they would be suitable for them. Obviously we can’t know everything, and there’s a lot we don’t know. So part of our job is reading up on things patients tell us about before their next visit.

How does studying medicine work in the UK?
The basis is a five-year course in medicine, but after the second or third year you can interrupt your medical studies for one year and join the final year of a BSc course in biochemistry or physiology or neuroscience and so on. Or you can take a one-year masters course and then go back to medicine. It’s a great way to get a more in-depth understanding of a particular field. I got a bachelor’s degree in cardiovascular physiology, finishing with four months’ research in the cardiac electrophysiology laboratory.

Practical experience is essential when you’re studying. Where do you get that?
I’ve done practical experience, and seminars and workshops with patients in hospitals, since the first year. From the third year onwards medical students don’t have classic lectures, and instead they’re assigned to hospitals where they spend three or four months.

What happens after you graduate?
Next there’ll be Foundation Years 1 and 2, the equivalent of the Czech “carousel”, where you’re assigned to various specialised departments at Czech hospitals. Under the national programme you’re assigned to a particular region for specific four-month rotations, such as general surgery, cardiology, traumatology, orthopaedics, psychiatry, district physician… and after those two years it’s up to you. For surgery you have to do two years of core surgical training and then speciality training, which is like the first and second certificates in this country. After you get your CCT (Certificate of Completion of Training) you’re put on the specialist register, which means you can work as a consultant in your specialisation.

With certification it all adds up to long years of study. How old will you be before you’re a fully-fledged cardiologist?
I’ll be able to work independently as a consultant when I’m around 36 or 37.

Medical students are also taught how to communicate with patients, but after they graduate they often find they don’t have much time for long conversations…
In the clinical exams at university the patients themselves also grade us. Even if our diagnoses are perfect, we can fail the exam if we don’t take a professional approach to our patients. Even when doctors don’t have much time to examine their patients, they have to be accommodating and show empathy, because that can make the difference between a correct and an incorrect diagnosis.

Do you have any experience of the Czech healthcare system?
Only as a patient. What surprised me the most was that the doctor-patient relationship in this country is generally paternalistic. The doctor decides what course treatment should take and the patient is mostly passive. A couple of times the doctor would be staring at his computer and wouldn’t even look at me, let alone shake hands, and then I didn’t feel like telling him any more than was absolutely necessary.

So ultimately you saved the doctor’s time…
But that’s wrong, because with health problems even seemingly trivial information can be crucial for correct diagnosis and treatment. And this attitude increases the risk that I’ll have to go back to the doctor with the same problem. So even in terms of time it’s worth paying proper attention to patients. But I don’t know if this is only a problem with a few doctors, and I was just unlucky, or whether it’s a systemic problem in Czech healthcare.

One advantage under the Czech healthcare system is that everyone gets the same standard of care regardless of how much tax they pay. Is it the same in the UK?
Healthcare in the UK is financed from tax, which is roughly five percent of your gross salary. The only fee is eight pounds for a prescription. It means everyone is entitled to the same healthcare. The exception is private healthcare, which you have to pay for. The system of private healthcare providers is fairly extensive in England, and the standards are high.

Doesn’t that mean that if you’re rich you go private and if you’re poor you’re stuck with the National Health System?
No, because the first choice is always public healthcare, which provides very good treatment. But unfortunately there are long waiting lists in the public sector, which is why patients sometimes go private.

In the Czech Republic a doctor gets approximately 66,000 koruna a month. What about in the UK?
Doctors who’ve just completed their studies get 22,636 pounds (roughly 656,000 koruna) a year without overtime, and in their second year of work it goes up to 28,076 pounds (about 813,000 koruna). Doctors working for their certification get between 30,000 and 47,175 pounds. Depending on how long they’ve been working, consultants get between 76,761 and 103,490 pounds a year. So there are massive differences between salaries, plus living expenses are significantly higher than in the Czech Republic. Doctors’ pay is a big issue in the UK, just as it is here. Recently the media found out that London tube drivers with only basic education get 49,673 pounds a year on average (about 1,400,000 koruna), which is more than double what new doctors get.

What are British people like?
They’re very polite. They won’t apologise just once, but a dozen times. They’re rarely very direct and they always skirt around the subject a bit, which doesn’t really suit me. I often have to be careful not to offend people by being too blunt. But I like the way they don’t complain as much as Czechs. And if there’s something that bothers them, they’ll actively try to change it. They’ll go into politics, set up interest groups, get involved.

Many young people who study abroad don’t come back to the Czech Republic. Will that be the case with you after you graduate?
I’m definitely planning to come back, but I don’t know how far off that’ll be. Ideally I’d like to complete all my qualifications in the UK and then I’ll see. Sometimes I tell myself I’ll come back sooner rather than later, because my parents are getting on, I miss them and I’d like to be near them. In the end it doesn’t really matter if I’m working as a doctor here or in England. If my profession works out, I can have a good academic and private life in both countries. (smile)
The Kellner Family Foundation
Renáta and Petr Kellner set up The Kellner Family Foundation in 2009. Since then it has supported academically gifted children and young people who are growing up in children’s homes, single-parent families and other challenging socio-economic environments. Subsequently the foundation has begun working to improve the quality of teaching at state primary schools in the Czech Republic, facilitating and extending opportunities for teachers to learn new and better ways of teaching their students. The foundation also gives grants to students graduating from Czech secondary schools so they can continue their education at universities in other countries, and it pays their tuition fees as well as travel or living expenses and other costs.

Libor Mysliveček (24)
After attending the Open Gate Grammar School, Libor Mysliveček is now studying general medicine at the University of Bristol in the United Kingdom, thanks to scholarship from The Kellner Family Foundation. He has been involved in several research projects and summer schools, as well as a volunteer programme in the spinal rehabilitation unit at Motol Teaching Hospital, and he has also had internships in the interventional angiology department at Vinohrady Hospital and the general surgery and orthopaedics department at Shri Ram Hospital in Jodhpur in India. His hobbies include reading, music, learning, floorball and swimming.

Photograph caption| A PRESTIGIOUS UNIVERSITY. The University of Bristol in the United Kingdom provides one of the finest medical educations in the world.
Photograph caption | TELL YOUR DOCTOR EVERYTHING. With health problems, even seemingly trivial information can be crucial for correct diagnosis and treatment, says the medical student.
photograph: Robert Sedmík
@Vladimír Barák, Týden magazine
We are grateful to Canadian Medical in Prague for allowing us to photograph on its premises.


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