Stefanos Demertzis M.D. is an Associate Professor at the University of Bern and Head of the Department of Cardiac Surgery at Cardiocentro Ticino in Lugano. His special clinical interests are minimally invasive coronary and reconstructive valve surgery, as well as interdisciplinary approaches in acute and chronic heart failure. His research focuses on flow visualization and the development of medical devices. In his free time, he trains for triathlon and publishes his widely-read blog on heart health – heartmatters.ch
As a cardiac surgeon, you have experienced holding a beating human heart in your hand. What thoughts go through your mind at such a moment?
It may sound unromantic, but at that particular moment my thoughts are completely technical: where we are in the procedure, or whether I see something unexpected. I must try to blank out any thoughts about who the person on the table is if I am going to perform at my best. Before the operation and after, of course I am thinking constantly about the patient, the patient’s family, the lives that are affected by the illness. And when I consider the heart, I feel intensely the beauty of the human organism and the beauty of creation. Touching and opening hearts gives me a unique opportunity to admire them, and through them the miracle of life. All good surgeons need the ability to blank out sentiment – almost to switch their humanity on and off. My relationship with my patients and their families therefore goes through three phases: intense empathy in consultation, pure technical focus during surgery – where the individual is represented only by his or her specific anatomy or medical issues – and then supportive, empathetic care during recovery.
Many physicians distrust the Internet’s wealth of medical information because they feel it damages the doctor/patient relationship. What made you decide to embrace it?
To be frank, I am very careful when it comes to medical topics, especially those found after a Google search – but it is the most common approach people choose nowadays, so we have to deal with it… When people need medical attention, they naturally turn to the internet to search for specific knowledge. You’re giving control over your body to somebody else; it’s normal to want information. The problem is that most of this information is unfiltered; the recipients can’t judge whether it actually applies to them. They can easily start thinking like consumers, rating treatments the way they compare the specs of a TV, or the tread on car tyres. Then when they visit their physician, it’s not just useful background they bring – it’s a shopping list: I want exactly this procedure, performed exactly in this way. This creates a breach in the delicate relationship between doctor and patient, because they may not accept why the treatment you propose differs from what they saw on the Web. It takes time before they ask: “Or is this not suitable for me?” So I felt the need to communicate through all the channels available, such as Heartmatters, to provide more filtered information. I’m not the first or the last, there are millions of pages out there, but it was a real need and it has been confirmed by the patients’ response. I feel that we are expanding the conversation to get outside this consumer/provider level.
You also train as a triathlete. What parallels do you see between this and your profession?
There are indeed parallels. My mantra is “continuous improvement”. It applies to both, triathlon and profession. It is a constant quest to improve my skills and understanding. All three disciplines in triathlon are highly technical – even running, if you want to streamline your training and avoid injury. So I focus closely on technique to try to become just that little bit more efficient or successful, not in terms of competition, but in achieving balance, health and feeling fully alive. You learn to sharpen your focus on each technical issue, something which is also absolutely essential when operating. The sensation of continuous improvement is so enjoyable – each race, each tackled task, is a celebration. The journey is the reward. Don’t get me wrong, in the case of surgery, the reward is a positive outcome for the patient.
What are the most exciting developments you see in the near future of cardiology?
The research that I have the opportunity to do at the university is another path to ongoing improvement, helping to move things forward, to improve what I and others can do for our patients. It’s fascinating. This is a great time in cardiology, the technological and biochemical advances being made at the moment will transform the field. We can already do things that were unthinkable fifteen years ago, thanks to new technologies. At the biochemical level, what we are learning about intercellular and intracellular signaling pathways may make it possible to cure many kinds of heart disease before they produce the complications that we now have to treat. But here, too, the information needs to be filtered: these advances may not be as complete as they are described in marketing materials or press reports. Journalists rarely have the training in science they need to judge how important a discovery or invention is – that’s where I come in, to try to give my readers a better-informed view.
When it comes to heart disease, prevention is obviously better than cure: are there things we can all do to maintain a healthy heart?
Well, I certainly wouldn’t want to see you as a patient in my operating theatre! To keep your heart healthy, start with diet and follow Aristotle’s advice: “nothing in excess.” Aim for balanced nutrition, with no exaggeration at either end of the food pyramid. Limit the toxins you expose yourself to: from a heart health point of view, smoking is simply the worst habit you can have. Do physical activity – but this doesn’t have to be extreme sport like triathlon: just regular activity for 30 minutes at least three times a week. Something that makes you sweat, gets you to leave your comfort zone and breathe more quickly, but you should still be able to talk. This applies to whatever activity you choose. Finally, strive for a balanced soul… think, reflect, be aware. Apply the brakes to the frenzy of everyday life. Whether it’s art, literature, religion, sport – whatever brings you to that state. Reduce stress, always remembering that this doesn’t mean being inert: you can be passionate and active about something that reduces your stress levels.
If you had not been a cardiac surgeon, what would you have been?
I had the choice to study architecture and law: both very structural disciplines, with a broad view but important details, which demand dedication and passion to pursue properly –just like surgery! I still have a passion for design and architecture and try to keep up with it through books and journals. Where I live in Ticino, there are some excellent examples of beautiful buildings, both historical and modern.