LETTER FROM CH. KANAKA

In short, what are the changes that are happening around us that affect the practice of Pediatrics? First (1) demographic changes. Greece together with Italy and Spain are the leaders in the low birth rate, the population of Europe is aging, economic migration is increasing with negative and positive effects on the indigenous society. On the other hand, (2) social changes and problems are increasing, for which the Greek and other societies are not ready to face. Today there are large percentages of parents raising children on their own. Divorce has risen to alarming levels, with working couples already making up the majority. All of this reduces the ability of parents to communicate with and supervise their children. The potential for exposure to addictive substances has increased significantly. Nicotine, alcohol and hard drugs circulate almost freely, and Greece is a leader in the use of alcohol by adolescents in Europe. With the westernization of Greece, and the changes that this entails, school pressure and peer pressure have increased, while the sexual revolution has reached here as well. Adolescent suicides, pregnancies, venereal diseases are on the rise. (3) The dramatic progress of Science and Technology and the need for the constant adaptation of the pediatrician was the subject of my presentation last year, to which I will not refer today. Finally, (4) the changes in social security that have recently taken place in the United States of America (USA), and countries of the European Union (EU) and that are now happening in Greece, are leading pediatricians to work, financial and moral pressures. Alcohol and hard drugs circulate almost freely, and Greece is a leader in the use of alcohol by adolescents in Europe. With the westernization of Greece, and the changes that this entails, school pressure and peer pressure have increased, while the sexual revolution has reached here as well. Adolescent suicides, pregnancies, venereal diseases are on the rise. (3) The dramatic progress of Science and Technology and the need for the constant adaptation of the pediatrician was the subject of my presentation last year, to which I will not refer today. Finally, (4) the changes in social security that have recently taken place in the United States of America (USA), and countries of the European Union (EU) and that are now happening in Greece, are leading pediatricians to work, financial and moral pressures. Alcohol and hard drugs circulate almost freely, and Greece is a leader in the use of alcohol by adolescents in Europe. With the westernization of Greece, and the changes that this entails, school pressure and peer pressure have increased, while the sexual revolution has reached here as well. Adolescent suicides, pregnancies, venereal diseases are on the rise. (3) The dramatic progress of Science and Technology and the need for the constant adaptation of the pediatrician was the subject of my presentation last year, to which I will not refer today. Finally, (4) the changes in social security that have recently taken place in the United States of America (USA), and countries of the European Union (EU) and that are now happening in Greece, are leading pediatricians to work, financial and moral pressures.

Data from the US Census Bureau are alarming. With the exception of the US with a growing population, European countries and Japan have projected population declines of 9 to 32% over the next 50 years. The working population is projected to decrease from 11 to 47%, while the percentage of the population over 65 will rise from 41 to 61%. American numbers differ mainly due to the open immigration policy of this country. On the other hand, data from the Athens Medical Association for doctors are also negative. The demographics of doctors and pediatricians in our country are constantly deteriorating. In a year from today it is predicted that in the metropolitan area of ​​Athens we will have about 1 doctor per 120 inhabitants, ie double to four times the number of the respective capitals of Denmark, Sweden and Great Britain. Five percent of pediatricians in the capital are in the unemployment fund.

Obtaining a pediatric subspecialty or studying a special subject can not be just clinical education. Young people who want to pursue a career in specialization should have academic aspirations. This training must be of a clinical and research nature. The second requires a protected time of at least two years, ideally with a parallel degree such as a Masters or Doctorate, depending on the subject.

The Teaching Research Staff (DEP) of the Clinic must fully participate in the academic triptych of university pediatrics with time protected for the preparation of teaching and research. The importance of a clear knowledge of the duties and expectations and of a fair and constructive evaluation from the top down, that is, from the supervisors and the students – undergraduate or postgraduate students – is enormous.

The following definition beautifully describes the importance of work in the quality of life of the individual: some kind of life rather than a kind of death from Monday to Friday. ” (Studs Tercel: “Working”, translated by A.-I. Antoniou)

The conditions for maximizing the efficiency of a University Clinic are those that ensure happy and satisfied employees. The university (or pediatrician) performs extremely interesting, complex, responsible, and socially useful work from which he / she must derive maximum satisfaction. Therefore, the environment must provide the best possible conditions for the best possible result in fulfilling the three-dimensional mission of the clinic.

What do you expect from pediatric education? In principle, a gradual increase in duties and responsibilities should be given under strict supervision and gradual independence. The clinic should offer a variety of knowledge and experiences that cover the breadth and depth of Pediatrics with exposure to a variety of topics and teachers. It is clear that in order for new pediatricians to survive in the future practice of pediatrics, which will be predominantly scientific, they must learn to use the scientific method throughout their active careers. Their participation in the research of the Clinic at least on a mental level is necessary. As in any work environment, young trainees should be fully aware of their duties and the expectations of the clinic.

Sir William Osler’s medical education system, which began in the 19th century, I lived as it is. This system has the following principles: (1) Military hierarchy and discipline, (2) Continuous recycling of trainees and teachers, (3) Graduation of the duties of trainee doctors with gradual increase of responsibility, with complete immersion (Immersion) of the first year in clinical practice, with almost superhuman requirements. Osler’s genius saw in his system the fight against fossilization and boredom, the variety of clinical experiences and exposure to people and knowledge, and the learning of clinical practice regardless of the possible temperamental approaches of the respective superiors.

What are the basic principles for the proper functioning of a University Pediatric Clinic? 1) Selection of the newly hired trainee and qualified staff based on evaluation criteria, 2) Continuous renewal and recycling of teaching and research staff, and 3) Expansion of the faculty with the participation of worthy colleagues from the NSS and the private sector, if they meet the criteria.

What is immediately missing in our Clinic and can and should be done? 1) Cardiopulmonary resuscitation. It does not mean today a clinician who is not trained in the modern approach of the dying patient and can be saved. 2) Development of sub-specialties, such as Adolescent and Pediatric Physiatry, which strangely have not landed in Greece. 3) Improvement of workplaces and hospitalization, based on the health and happiness of patients and staff, and for the optimal execution of the mission of the clinic.

Finally, I would like to refer to the research work of the clinic. This requires liveliness, fun, good night and passion. We often need research, data presentation, teaching seminars. We need constant communication with the international scientific community, collaborations with colleagues at home and abroad, exchanges of postgraduate students and members of the Clinic with colleagues abroad, international guests who come to teach us but also to be taught. We need undergraduate students with an interest in research initiation.

Aristotle used to say, “Nature’s appetite for seeing man”. In reality, however, it is a small percentage of people for whom the acquisition and production of knowledge is an object of joy and happiness. It is the duty of every person who comes in contact with children to infuse them with this blessing which now concerns very few.

The problem of finding people with a real interest in science and academic medicine is not only Greek. Physician-Scientist is rare and a major problem in the United States. and the EU, to the point that there is a lack of replacement of the current doctors-scientists in the next 20-30 years. At the Life Science Forum, FASEB (14: 221, 2000) the following suggestions were made to solve the problem: 1) To emphasize the importance of the career of the doctor-scientist to politicians, the public and young people. 2) To give financial incentives. 3) To stabilize the programs with continuous financial and infrastructural support. 4) To stabilize the distant career of those who enter this path. 5) To monitor the career of doctors-scientists in order to learn lessons and make improvements.

In short, a successful University Pediatric Clinic is a living organism where clinical practice, teaching and research are interrelated. Such a clinic should include centers of clinical excellence with national and global scope, where the production of essential new knowledge, where there is active participation in the world science of Pediatrics, and the production of tomorrow’s independent and self-evident leaders. Let us not forget that:

” Improving children’s health depends on research, and service delivery requires a culture that constantly examines and judges ” (A. Aynsley-Green, Arch. Dis.Child. 78: 101-110, 1998)

Professor Christina Kanaka Gantenbein
Director – 1st Pediatric Clinic of the University of Athens