If you are curious, your chances of becoming a better professional increase

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When you contact a well-known physician, you expect to meet a difficult and, sometimes, arrogant person. That is, if the person has the decency to reply to you... But this time I was very nicely impressed with the attitude of Prof Dr Pedro Brugada, who in 1992 discovered together with his brother, Josep Brugada, the eponymous cardiac syndrome. The photo of the eight-year-old Polish child on whom the syndrome was diagnosed hangs on the wall of his office. Prof Brugada was very friendly and open, and the interview was pleasant and inspirational.

Brugada Syndrome is one of the primary causes of sudden death due to arrhythmia. It is a hereditary disease, being the second leading cause of death in young adults and children in some countries.  It is visible on the electrocardiogram (EKG) and its treatment includes an implantable cardioverter-defribillator. Arrhythmias are irregular heartbeats that can cause stroke or sudden death. They can be detected on EKG or through more complex investigations. Symptoms include palpitations, lightheadedness and loss of consciousness. Sometimes patients may experience no symptoms at all.

Prof Dr Pedro Brugada, an arrhythmia specialist, is the head of the Heart Rhythm Management Centre at UZ Brussel-VUB (Free University of Brussels). He has been a professor since 1986, member of many cardiology professional associations, reviewer of prestigious scientific publications (The Lancet, European Heart Journal, American Journal of Cardiology, Nature, etc.), scientific and editorial board member and also author of more than 1000 articles, abstracts and scientific book chapters.

Born on August 11, 1952, in Girona, a city in Catalonia, Spain, Prof Brugada grew up in Banyoles, an idyllic small city surrounded by mountains. He enjoyed healthy meals at the farm of his father who was raising chicken and rabbits. Bread with olive oil and tomatoes is still one of his favorites after all these years. He is against butter or margarine, especially if it is not used in moderation. Regarding sport, he enjoyed swimming as a child, "I was a swimmer as all my family was. At that time, there were no other facilities on that beautiful lake other than swimming or rowing. From a very early age, everyone in town did one of these sports." Talking about food, I was curious to know what his opinion is about eating eggs, now that they are not considered a major cause of high cholesterol anymore: "Recent studies emphasize what we already knew from the diet of nuns and monks who eat a lot of eggs, and they are just fine. It is very difficult to take out one item from a diet and to pass judgment on it. We talk about cholesterol, but 80 % of cholesterol in your blood is produced by you and just 20 % comes from outside, so you have little control over it. You can manage the problem if you attack your metabolism with pills, with statins. But studies now show that statins aggravate health problems, so you lower your cholesterol level, but you could worsen other health conditions (atherosclerosis). So to avoid high cholesterol, you need to have a good BMI (body mass index) and a good abdominal circumference. Whatever you eat, do it with moderation and variation."

Professor Brugada began his university education at age 16, studying medicine and philosophy in his first undergraduate year. Due to his excellent good marks and his mother's encouragement, he chose to study only medicine. To finance his studies, he did a lot of small jobs, even being a street musician.

After graduating at age 22, he started working as a general practitioner in Ripoll and then he moved to Taragona. During this one year as a general practitioner, he learned to respect this speciality.

What do you think is the most important piece of advice a general practitioner could give his patients with regards prevention? - "There are five important factors in cardiovascular disease prevention: inheritance, where you cannot change too much, smoking, diabetes, hypertension, and high cholesterol. The general practitioner can have an important influence in helping the patient to lead a healthy lifestyle, that is, in stoping smoking, controlling the cholesterol level, high blood pressure, sugar intake, and in encouraging regular exercise. You, as a patient, can control most of these factors, such as quitting smoking or never even start it. I was a smoker and I stopped suddenly, from one day to another, exactly as my father did. This is the only way, to be convinced of it. Once you stop, don't think you have it under control. If you start again with one cigarette or two... you will start to smoke again." What about electronic cigarettes? - "It is very controversial. On one side you avoid the risks of the normal cigarettes, but now studies show that the inhalable vapor can be even more dangerous than the components found in a normal cigarette. This shows how products get on the market without being sufficiently controlled by health authorities. The idea that the electronic cigarette is better than the normal one is being challenged very seriously today."

A healthy habbit recommended by Prof Brugada is walking. "One of the things you can do for your patients when they get sedentary is... to tell them to buy a dog and walk with it. The healthiest sport for the normal person is walking. If you want to do a bit more, walk faster. Scandinavian people do that and it is very good for older people. Jogging can put your knees at risk. On soft terrain it is OK, but running on the street as many do is not good for your knees. So for people who want to be in a good condition, who don't want to be exposed to many risks and at the same time enjoy an activity, the best is walking, and if you do it with a dog, it is faster. I recommend this for all my patients over the age of 50."

Prof Brugada didn't plan a career in cardiology; he wanted to be a hematologist (blood specialist), but the professor in charge at that time, Prof Dr Cirilo Rozman, a  hematologist and chief of medicine at the University of Barcelona Hospital Clinic, postponed his plans for one year, considering him too young. At that moment, Prof Brugada contacted Prof Dr Francisco Navarro-Lopez (Paco), who had just become the new chief of the Department of Cardiology, to join his team made of Dr Amedeo Betriu and Dr Gines Sanz. They were light years ahead of their time in their field, and the hospital clinic has maintained this reputation for modernity ever since.

It was not easy financially during his cardiology residency, especially because Dr Brugada was a married man with a daughter. His professor, Paco, initiated a type of medical game (on congenital heart disease) so he could "earn" his lunch. He had to make the right diagnosis based on clinical history, physical exam, EKG and an X-Ray of the thorax. If he succeeded, Paco paid for his lunch. It was a very efficient way to learn cardiology.

His knowledge on heart electrophysiology  (how the heart works) at that time  was not vast, so Dr Brugada translated a book on Emergency Medicine from French to Spanish, and with the money received he bought a book on electrophysiology written by a Dutch doctor. As the next step, he decided to learn even more in practice, so he self-financed his internship to Maastricht for six months. " I always said I like Spain for the scientific misery. I could have started my practice as a cardiologist there, but I wanted to know more about this new field of electrophysiology that had started in the '70s in Amsterdam, Paris and later on in Chicago. I really wanted to learn something about it. I asked for a fellowship in Maastricht, but I got only the symbolic amount of 250 euros from the Spanish Society of Arrhythmia, enough to pay my tickets. I saw a completely new world in Maastricht, a new culture. I was forced to learn a new language and a totally different world opened to me, not to mention all the books I could read in Dutch. "

Is there something missing in today's education of medical students? "It is very passive. I experienced a special type of education that is not possible anymore today. When I finished the first year of medical school, Prof Valdescasas, professor of Pharmacology, was waiting for me at the exit of the university. He asked me to join a special program due to my good marks. In the first year of medical school we were 2500 students, 525 graduated, and 25 were asked to join this special program. It was a research center that did not belong to the univerity. After this I never attended a class anymore. We were the first year in Pharmacology laboratory, learning everything about research. In the third year I was in the Rheumatology Department and Emergency Room, participating in consultations and actively in all activities of the Emergency Room. I saw between 50-300 patients with different acute pathologies per day. Everything was very practical. The fourth year I started in the Department of Hematology and the fifth anf sixth year I was actively participating in all medical activities, and, of course, continuing my work in the Emergency Department. So when I graduated from medical school, I already had five years of practical experience. It is very different from today when students are sitting and listening to a professor for five years. This difference is because there are too many students today. If you want to learn medicine, you stay with the doctor the whole day and learn from him."

How does an experience abroad influence a medical doctor? "I think an experience abroad is very enriching. You have to see the world. You have to be curious because this increases your chances of becoming a better professional. You ask yourself questions which is the basis of progress. When you are curious, you basically want to know something and this is either because you don't know it and you want to learn it, or because nobody knows it and you want to understand and discover it. The major progress of science comes not from what we know but from what we don't know. What we don't know makes us question it and this facilitates the path towards the answers. In 2003, at the invitation of The American Heart Association, I gave, at the prestigious Paul D. White International, a lecture in front of 10.000 people. Usually you talk about what you have achieved in your life. But I talked about the opposite - ignorance. I explained to the audience what I don't know. This had a huge impact in the media. I explained that the driving force of progress is ignorance; we have to focus on what we don't know, not on what we know. You can do this only if you are curious. This attitude brings you out of your comfort zone. When you start this, you must continue."

You have often mentioned that you have been lucky in life - "Yes, I was very lucky. We don't have control over everything. Your life is made according to the Greek Y - everytime you take a decision, you change your life completely. If you believe in external forces (God, good luck or mathematics through chaos) you can say it is because of these. If I had not gone to Maastricht, we would not be sitting here together. There would be two other people like us sitting and talking now. This is what the chaos theory says. Just imagine, if I had chosen to be a general practitioner, or had waited one year to start my hematology residence, I would have had a completely different life now. I was lucky because I dared to change frequently, not only in my private life - I have been married three times. Maybe it is not the normal way to do it, but I am very happy. Last time I got married was eight years ago, at 55 with a Flemish woman."

What was the driving force in eveything you did? - "I don't feel good if I have too much comfort. If you want to kill me, put me in a hotel room for three days and tell me I can do nothing. Because of my curiosity, where others see problems, I see opportunities. For example, I often spent my holidays in Estepona, Spain. I had a Jewish patient from Gibraltar and I told him, you know, let me call you back because I can see you maybe in Estepona. I called the cardiologist there, I saw the patient and this is how I have started the center in Estepona. I also work there now.“

You are involved in politics. Do you think politics can contribute to the improvement of the health of people? - "My role in politics is limited to the social securiy system. I am vicepresident of the local OCMW and the president is a lawyer. It is about money, regulations and health. We make a good team together because of our jobs. It is also a social service on my part, giving my time back to society, to help others. In a way, I think it is an obligation and everyone should do it. On the national level, I think the obligation of the government is to control those factors that lead to a healthier life for people. This is not always happening in reality. I proposed a screening program for Belgium (Prestige Project screening program that costs 250 euro/person during 24 years-n.r.). I had promises from private companies to financially support the free screening of all 12-years old children from Belgium, but politics blocked it, probably because of jealousy. The Flemish Minister of Health, Mr Jo Vandeurzen, asked for advice from the Hoge Gezondheidsraad (Superior Healthcare Council) and they said the program was not necessary. So the minister rejected my project. They didn't even ask me to come present it. Can you imagine this? What is happening now? Everybody is going to the cardiologist very frequently and this is paid by the social security... paradox of politics."

Life in Brussels - "It was an opportunity, here in Brussels. The Department of Cardiology at UZ Jette was dying and I am glad I came. We changed mentalities here: I became the first self-employed professor in Belgium. Now we have 38 self-employed professors at this university (VUB). It is better because we have special conditions - you must work harder. Your salary is independent of the number of patients you have per day. This is disappointing on the long term because you get into a routine, a comfort zone, and if you don't get out of it you have no good initiatives. The best solution is a combination of both: the majority of our employees at our hospital work part time, so in my department people work 80 % of the time and the rest 20 % they can do anything they want to, but in such a way as not to compete with the hospital. For example, the patients who come to my private practice in Aalst and need a surgery, they must come to this hospital. It is a win-win situation. My employees make more money with the 20 % of their time than with the 80%, and the hospital gets the patients. It is nothing new. It is the philosophy of the Google company which gives its employees 20 % free time to invent, to be productive."

Have you realized other professional projects or do you have any future plans? - "I have a multidisciplinary center in Aalst with four other cardiologists, a cardio surgeon, a vascular surgeon, a gastroenterologist, a physiotherapist, a dietician and a sport doctor. We are also looking for a diabetes specialist. For the future, I would like to have a center for continuous monitoring of patients and sportsmen via Internet. We have already started to work on this project. It is about a chip that gets implanted in the patient, and when there is a problem the ambulance would come immediately. Now we have this for fibrillates for sportsmen. Unfortunately, politics lags behind technology. For example, drones can still not fly in Belgium. I could program a pacemaker from the distance, but it is not  legally allowed.“

Thank you.

Interview realized by dr. Ioan Hanes