Cardiologist Gabriel Tatu-Chițoiu: “If I hadn’t been an optimist, I would have left the country long time ago”
Being the President of the Romanian Society of Cardiology (SRC), Gabriel Tatu-Chițoiu teaches people how to take care of their heart, and he doesn’t do it by preaching, but by setting a personal example: he does sport, he has won medals at Medigames (the annual “Olympics” of MDs around the world) and he runs a sports club – Athletic Cardio Club. Under his leadership, the SRC carries out innovating awareness campaigns regarding the four big risk factors that are causing cardiovascular diseases: smoking, high blood pressure, a sedentary lifestyle and high level of cholesterol.
If cardiovascular diseases are considered “the number one murderer” of contemporary people, MD Gabriel Tatu-Chițoiu works in the “first line of war.” Almost every day we hear about people we know who have heart related diseases, but the president of the Romanian Society of Cardiology (SRC) believes that “medicine has made huge progress in the last 15-20 years, and cardiology is a field where evolutions are absolutely spectacular. I am convinced that, soon, we will witness a new quality leap, that will lead to treatments on the molecular level.”
Statistically speaking, things are clear. “In 1987, when I started working at the coronary intensive care unit, within the Floreasca Emergency Hospital – a Unit where I have been working ceaselessly up to this day – the death rate of myocardial heart attack was somewhere between 20 and 30%. During all this time, the death rate of the last five years dropped under 5%. This is a significant reduction, and it is mainly the result of interventional cardiology”, explains medic Tatu-Chițoiu.
But the success we have obtained in the fight against these diseases cannot be solely arrogated to the development of medical technologies, but also to the “understanding of the risk factors that lead to counter-attack measures and also to the possibility of controlling these diseases; for example this is the situation of France who reached the longest life expectancy in the world – 83 years for men and 88 for women – more than the Scandinavian countries or Japan.”
On the other hand, living a longer life is not a goal in itself: “It is one thing to have a long, healthy, active and, eventually, a productive life for as long as possible, and it is another thing to spend your life following all sorts of treatments, without being useful to the society.” Therefore, the objective of the cardiologist is not only the restoring of health, but also the prevention of its decline by convincing people that they can fight the risk factors of cardiovascular diseases on their own.
A healthy life – an ideal that is difficult to attain without the education
As a Bucharest medicine graduate, in 1977, afterwards as a rural physician, and finally as an intrenal medicine physician and a cardiology specialist at one of the country’s busiest emergency hospitals, MD Tatu-Chițoiu says that he got to know all types of people.
And one of the observations he made during all these years that is legitimate also today is the following: “the patient goes to the doctor to get a pill that works for everything. Maybe he has a headache, maybe his knee is hurting, or his stomach…But, he is not aware that all his problems could have been avoided, if he had some basic knowledge. Most countries have a weak spot here – education for recognizing, preventing and efficiently fighting the main factors of risk – but there are countries who realized that it takes education to accomplish all these and they have obtained successful results.”
“It is very difficult to re-educate older generations because they lived 40-50 years with certain habits,” says the doctor. The best example is set by the poor results obtained in the fight against smoking. “With all the efforts made to convince a smoker to stop his habit – an effort thar includes psychological counseling sessions – only eight out of one hundred smokers are actually quitting. Therefore, the rate between the costs and the benefits of such a campaign is very low.”
However, the physician is optimistic when it comes to the younger generations. Firstly, because “young people are more and more interested in having a healthy lifestyle, because they work in the private sector and they desire to be healthy, active, so they can keep their jobs.”. Secondly, young people have “other sources of getting information, they use social media networks where the information can be widely spread at the same time to a very large number of people.”
The optimism of the SRC president is based on the successful results he observed in other countries, returning again to the example of France: “The efforts of French people are so serious, that they are forecasting that in the next twenty years they will have the first entirely nonsmoking generation.”
Applied cardiology… at the level of the whole society, not only in hospitals
The project that made Gabriel Tatu- Chițoiu president of SRC was based on the concept of removing the strictly academic frameworks and on the involvement of the organization, on the one hand, in identifying the cardio-vascular related problems and, on the other hand, in providing solutions – in partnership with other medical professional associations (pneumology, general practice, neurology, diabetes) and with the decision makers: the Ministry of Health and the Ministry of Education. There were created distinct programs for each of the four cardiovascular risk factors.
The fight against smoking had a large success at the beginning of 2016 when it was completely forbidden in all closed public spaces, by the modifications brought to law 349/2002. “The old format of the law provided the setup of separate spaces for smokers and for non-smokers, but these turned out to be a malfunction. The law doesn’t stand against smokers, it is a law against passive smoking, thus allows for the protection the non-smoking majority of Romania, that is 74% of the people”, explains the SRC president.
In order to fight hypertension, the SRC created a Self-diagnosis program. This program is bases on an online application (the website called tensiuneamea. ro), available also on mobile devices (the app Tensiunea Mea can be dowloaded from Apple Streo or Google Play. The idea of creating this app began from a crystal clear reality: according to the recommendations of the current medical practice guides, 15 minutesare required in order to correctly measure somebody’s blood pressure.
“A family doctor has on average 1.500 enlisted patients. A simple calculation shows us that only to correctly measure the blood pressure of all of his patients, the physician would need two months per year, eight hours per day. Which is practically impossible. According to some data, Romania has up to eight million people with high blood pressure. If these figures are real, regardless of how large the medical corps were, it would be impossible for them to correctly measure the blood pressure of all their patients.”
As a consequence, “the solution we believe in is that people learn to measure the blood pressure on their own; there are scientific papers that say the best prognosis is the blood pressure measured at home.”
Thanks to the online application, patients benefits from written instructions and a video recording, so that they can learn, on the one hand, about the consequences related to not diagnosing high blood pressure on time. On the other hand, pacients learn how to correctly measure their blood pressure. The results are introduced in the tables of the app. The data are automatically processed and, depending on the results, the user receives a preformed messagesuch as: “stay calm and measure it again in six months!” or “your blood pressure is high, go to the doctor immediately!” So, in theory, everyone is able to find out whether their blood pressure is high or low and patients an precisely know if the treatment they follow controls or not their blood pressure.
Concerning the fight against a sedentary lifestyle, MD Tatu-Chițoiu started out from the idea that: “it is pointless to tell people «Exercise or else you shall get a heart disease!», while sitting at my desk without being myself active.” So, in 2012, 17 physicians set up the Athletic Cardio Club (ACC – http://roacc.ro/) under the slogan Run together with us for your heart! In January 2016, the club had over 600 members, of which only a third were not medical staff.
“This is not just about organizing sports competitions that have no effect, because people should exercise every day. Everyone is free to do what they wish: walk, run, ride the bicycle (including at home, the stationary bicycle), swim or ski. There is an app called «Objective 600» where, at the end of each day, each club member can introduce, on their individual section, the number of kilometers they have achieved on that day. The top is generated automatically. Thus, there are tens of members who motivate each other by participating in compaetition that runs 365 days per year, under the «umbrella » of a sports club. Who has never dreamt of being part of a sports club?”
Each year, an award ceremony is organized, where diplomas are offered to those who went over the 600 km threshold the year before. The members reaching the first places, women and men, receive gold, silver and bronze medals for walking, running, swimming, cycling and skiing. It is worth mentioning that 65 of the club’s members participated in the last edition of the Bucharest Marathon. From the Medigames (the physicians’ yearly “Olympics”, held in Limerick, Ireland, in 2015), 13 members of the ACC returned with 32 medals.
Sadly, the ACC sponsors are scarce (because “everyone wants people to get intoxicated with medicines, they don’t want people to be healthy”, says the cardiologist), so the club’s members have to pay from their own pocket for the prizes.
For fighting the fourth risk factor – the high level of cholesterol – th SRC uses online dissemination of some informational brochures. Gabriel Tatu-Chițoiu points out that “the idea of reducing the cholesterol level is based on tens of years of studies on hundreds of thousands of patients. It is not an obsessive idea, «conspiratorially» induced by pharmaceutical companies. We have got to these data that certifying the fact that, when having certain levels of the «bad» cholesterol (known as LDR) under 70 milligrams per cent, the artosclerosis can be reversible; so, the deposits on the blood vessels start to go away. There are isolated populations, who live in Amazonia and who don’t have any heart related diseases. Their bad cholesterol is under 50. Animals have cholesterol between 50 and 70 without any medication.” The so called stress should not be an excuse for having bad habits The SRC president believes that if people were to consider the four risk factors and would get a medical control each year up to the age of 45, and then one every six months after this age, then we would live into an ideal world, where diseases could be discovered in early stages. Regarding stress, “this has a smaller influence than people believe or wish it had. Romanians blame stress for everything… Stress is not a major risk factor to say that everything is caused by it.”
What is the future of the Romanian medical system?
A discussion with the SRC president – an organization that brings together “1,500 exceptional physicians,” according to Gabriel Tatu-Chițoiu – couldn’t come to an end without asking him how he sees the future of the Romanian medical system. “I continue to be an optimist. I place great hope on the younger generations.If I hadn’t been an optimist, I would have been out of the country a long time ago”, says the cardiologist, who explained his view on how the medical system shouldbe managed.
“The policies who will fail for sure are the ones who are ignoring the human factor. It’s the same scenario as with the wars that are never won, although, from the outside it looks like you are better prepared than your opponent. You are better armed, but you can’t understand why you are not winning. And that is because you cannot control people’s minds. In the same way, if we want to run the medical system only through measures that are enforced from top to bottom, we shall never understand anything. If you carry out a dialogue with the people who are at the base of the system and you create realistic programs, together with them and drawing them to your team – and not using them as a team for your own goals – then you stand a chance to succeed. It is a matter of mutul trust. When each member of a team is justly valued, then the team becomes a winner.
In Romania, the system is shattered into pieces, with experts in decisions on the one side, and the professionals, the professional medical societies – on the other. Between them there is a fracture, a missing link and missing communication. Everything comes just from top to bottom. And there is one more thing: we still haven’t gotten over the model of the sole boss, the master over everything that moves, irrespective of the level of competence. Such a boss can become a brake. Certainly that even us we will understand, sooner or later, that the role of the head is to be a coordinator/ integrator of some departemnts run in their turn by the most competent in a particular medical subspecialty.
In other words, investing trust in people, making them responsible, creating the right framework, so that they can prove what they can do – surely, in this manner of organizing the work, even the boss has nothing but to win. You know how it is: authority can be imposed or earned. The second option brings in respect as well.”