本期仁醫(yī)醫(yī)療特別邀請到國際著名腎臟科專家Prof. Michael Fischereder做專題訪問。Prof. Fischereder現(xiàn)任慕尼黑大學醫(yī)學院教授、慕尼黑大學醫(yī)院移植中心腎臟科主任、德國內科醫(yī)生專業(yè)學會（BDI）巴伐利亞分會副主席。

因為童年興趣和中學的經歷堅定了Prof. Fischereder成為醫(yī)生的信念。他鼓勵年輕醫(yī)生多到不同醫(yī)療機構學習，找到自己的方法和研究興趣。作為德國腎移植專家，Prof. Fischereder分享了疫情之下，德國醫(yī)院腎內科遇到的挑戰(zhàn)與應對。

精彩回顧  

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1、您是何時決定從醫(yī)的呢？又為什么專攻腎內科呢？

Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in nephrology?

我在童年時期就對科學、自然科學和生物學等非常感興趣。當我到了該考慮職業(yè)的時候，我發(fā)現(xiàn)照護病人非常有意思。于是我在中學時期成為了一名救護車急救志愿者，這段經驗也堅定了我成為一名醫(yī)生的信念。

關于專攻腎內科那就是另一回事了。那時我在慕尼黑大學醫(yī)學院上學，期間我去了美國參加選修培訓課程，并有機會在一家腎移植中心學習，不僅是學習外科手術，還有腎內科的培訓。那是在1986年，我遇見了我生命中第一位對我大力支持的導師Karl Nath，當時他是腎內科的主治醫(yī)生。我在美國接受培訓期間他非常支持我，也是他建議我成為一名腎病科醫(yī)生。他為我選了一條非常適合我的道路。

Early on in childhood, I was very interested in science, natural science, biology. And when I was eventually thinking about career options, I found taking care of sick patients very interesting and wanted to learn more. And that actually is what brought me to volunteer time with a paramedic unit early on, still as a student at school, and eventually strengthened my understanding that I want to become a physician, a medical doctor.

With respect to nephrology, it was a different thing, because I went abroad to the United States for an elective training period, while still in medical school in Munich. At that time, I had the opportunity to visit a renal transplant service from either the surgical side and also the nephrology part. It was then, back in 1986, when I met my first very supportive mentor, Karl Nath, who was an attending nephrologist at that time on the consult service. He really supported me all along through my training and it was his interest to turn me into a nephrologist. And he was right. I think he made a very good suggestion for me.

2、您的早年經歷如何塑造你的成就？

How did your early youth experience shape your success?

我是我們家第一個醫(yī)生，我們家之前也沒出過多少科學家。在我成長的過程中，陪伴我的是住在附近的朋友們，大家雖然興趣不同，但是都非常有抱負。他們中有些人對銀行業(yè)感興趣，有些人對計算機科學感興趣，還有些人在軍隊中追求理想。由于我一直都對自然科學和醫(yī)學感興趣，也因為在這樣一個有抱負且雄心勃勃的環(huán)境中成長，讓我從醫(yī)學生一直到我成為醫(yī)生都備受鼓舞。

I am the first physician in our family. And actually, there aren't too many advanced scientists in our family, either. So when I grew up, I was in an environment with many friends from the neighborhood, who all were very ambitious, but in with different interests. Some of them were interested in banking, others in computer science, and a few pursued careers in the military. And as I always had been interested in natural sciences and medicine, living in a competitive and ambitious environment was support for me also to pursue training in school and then advance to a career in medicine.

3、您職業(yè)生涯中是否有對您來說很重要的導師，他們教會您什么，是如何啟發(fā)您的呢？

Who have been you greatest influences? What have they taught you and how have they inspired you?

對我影響最深刻的人是我的父母和我的兩位導師Karl Nath 和 Detlef Schl?ndorff。我的母親一直教導我，努力是取得成就的關鍵，叮囑我教書育人對學術生涯的重要性。我的父親是一個非常溫和的人，從他身上我意識到談判和人際交往技巧是多么重要。

我剛剛提到，在我醫(yī)學生涯和腎臟學的第一個導師是Karl Nath。他是第一個認為我在腎臟病學領域有天分的人，并且支持我在此領域發(fā)展。在我留美接受內科住院醫(yī)師培訓的三年期間，他給予我非常大的幫助。

然后是我的導師Detlef Schl?ndorff ，他把我從美國帶回德國慕尼黑，并且助力我在德國的職業(yè)發(fā)展。我從Detlef Schl?ndorff 身上學到最寶貴的品質：永遠以數據和事實為標準，即使面對自己做出的研究或者是好朋友的研究，也要非常謹慎、富有批判精神，基于數據和事實進行求證。

My greatest influences have been my parents and my mentors Karl Nath and Detlef Schl?ndorff. My mother, all along, taught me that it is crucial to work hard in order to achieve something. She always was the one who pointed out to me how important schooling in an academic career is. My father is a very gentle person who always showed me that negotiating and interpersonal skills are important, too.

My first, mentor in medicine and in nephrology, as I said early on, is Karl Nath. He really was the one who thought that I had a talent in nephrology and supported me that way. He helped me a great deal to also come to the United States and pursue a three-year clinical training there as an internal resident. From then on it was my mentor Detlef Schl?ndorff who brought me back to Munich, Germany, and supported my career here in Germany.

The most important thing I learned from Detlef Schl?ndorff is always to rely on data, rely on facts, and be very critical even if it comes to own research, even if it comes to research of close friends, to always, really look at the data and pursue research ideas based on facts.

4、從您自身經驗出發(fā)，對于一名醫(yī)生來說，到不同醫(yī)院或者不同國家訪問的重要性？

Based on your experience, how important is it for a medical doctor to visit different hospitals or different countries?

對我個人來說，到不同醫(yī)院訪問大有益處，我曾經在德國和美國多家醫(yī)院接受過培訓。不同醫(yī)院的病人癥狀也許是相似的，但是每個醫(yī)生的治療理念都是不一樣的。醫(yī)療系統(tǒng)的組織架構也各有不同。對于我來說，訪問不同醫(yī)院能讓我反思不足，并且汲取不同醫(yī)療系統(tǒng)的優(yōu)點。

我在德國上醫(yī)學院時，感覺德國的醫(yī)學教育偏重理論。到了美國之后，我意識到了實戰(zhàn)訓練的優(yōu)勢。對我來說，兩種模式的結合才是最理想的方法。

當我決定專攻腎臟病學時，我的第一份正式工作是在雷根斯堡大學醫(yī)院，跟隨著Bernhard Kr?mer教授，那里是學習臨床醫(yī)學和臨床研究的絕佳選擇。當我回到慕尼黑大學醫(yī)院追隨我的導師 Detlef Schl?ndorff時，我看到大型科研機構是如何進行基礎科學并與臨床和科研相結合的。

我十分鼓勵年輕醫(yī)生多到不同的醫(yī)療機構訪學，向不同的前輩學習，我相信每個醫(yī)生都會找到自己的方法，從不同的榜樣身上獲益。

For me, at least it was a great advantage to see different hospitals, and as you pointed out that I trained in a fair number of different hospitals, either here in Germany or the United States.

Although medical problems may be very similar, the personal attitude of treating physicians can be different and the overall organization of the medical system certainly are different. For me, this was a great way to really reflect on my training and gather different aspects of how medicine is practiced between the systems.

When I went to medical school in Germany, I felt that it was very driven by theory and learning from the books, then moving to the US I saw the advantage of very practical training. The two ways together formed, for me, the ideal approach. And likewise, when I then moved on to nephrology, my first staff position in Regensburg, with Prof. Bernhard Kr?mer, was a great site to learn clinical medicine and clinical research. And then moving back to my mentor Detlef Schl?ndorff here in Munich was an advantage to see basic science performed in a large institution and try to combine those two.

And I can only encourage people to move between institutions and learn from different people. Every individual doctor will find his or her own way how to personally profit from different role models.

5、作為多個腎臟病學相關科學學會的活躍成員，您認為這些學會對學科和醫(yī)生有何重要意義？

As an active member of multiple societies of nephrology, how important do you think these societies are to the field of nephrology and to the physicians?

在我看來這些學會為大家提供了非常多組織良好的教育活動，這也是我加入學會的價值所在。跟熱門學科如腫瘤學相比，腎臟病學是比較小眾的學科，同一時間沒有太多的科研項目。但是我認為一個能夠幫助腎內科醫(yī)生關注最新進展的學會是非常有益處的。與此同時，這些學會為新手腎臟病學醫(yī)生提供特別的培訓項目引導他們入門，這也是非常好的。

In my understanding, these societies offer a very good opportunity to organize structured educational activities. This is really, for me, the most added value from being in these societies. Even in a small field like nephrology with not so many research projects being done at the same time compared to fields like oncology, still, I find it helpful to have a society that helps all physicians in the field to focus on the most recent advances in the field. At the same time, these societies offer early-on support for novices in the field in order to get them introduced by special mentoring programs, which I find very fortunate.

6、您認為科研對一個臨床醫(yī)生有何重要意義？

To a physician, how important is scientific research?

我認為科研是每個醫(yī)生行醫(yī)的基礎，即使是不太積極參與科研的醫(yī)生，了解如何進行科學研究、如何整理科研成果對他們來說依然至關重要。因為治療患者應該始終以堅實的科學事實為基礎。當然，成為一名好的醫(yī)生還需要良好的人際溝通技巧，但是科學事實是不可或缺的。

作為一名臨床研究人員，我發(fā)現(xiàn)把成果轉化到病人照護上的臨床研究也是非常重要的。一名好的醫(yī)生必須要有理解科研成果的能力，并不是說每個醫(yī)生都得親自做科研項目，但是所有的治療方案都應建立在科學數據和科研成果的基礎上。

I think scientific research is the basis for every physician, even for those who are not actively involved in research. Still, it is crucial that they understand how research is done and how research is reported. Because treating patients should always be driven by solid basic scientific facts. Of course, it takes other skills in interpersonal communication. But the scientific basis is crucial. 

And as I am a clinical researcher, I find, also, clinical research that can really be then translated into patient care important. In order to practice medicine, one has to be able to understand the results of research projects. Not necessarily every physician has to perform his or her own research. Every treatment should be driven by scientific data and based on solid research.

7、您如何平衡行政、臨床、科研、教學工作及個人生活？

How do you balance your personal life, administration, clinical practice, research activities and lecturing?

這是一個非常難的問題，因為有時（時間安排）會有沖突。對于我來說，作為一名臨床醫(yī)生，我大部分的注意力都放在病人身上，我認為專注于照護病人是我的義務。除此之外，行政工作也是必要的，否則我的科室無法運轉。

科研和教學是抽空進行的，教學的時間一般是根據學生課表而定，而科研的時間安排更有彈性。除去這些活動，剩下的時間就是留給個人生活的。有時我感覺我留給個人生活的時間實在是太少了。但是沒辦法，這是我的職業(yè)決定的。我學醫(yī)的第一天起就意識到這一點了。所以假如一個人比較注重個人生活，那我不建議他選擇學術或科研道路。

This is a very difficult question because sometimes there are collisions. For me, as a physician involved with patient care, my patients often, if not to say, always have the first right to get my attention. I always feel obliged to really focus on treating my patients. Beyond that, certainly, administrative tasks are necessary in order to keep the department running.

Research is something along, like lecturing that can be done if you schedule your day, and then you can find the appropriate time slots. While lecturing is more or less given on the schedule for the students. Research projects, depending on the nature, have more flexibility. Well, now you see, adding up the last that's left is private life and sometimes I feel there's a little bit too little time for private life, but that comes along with the career. This is something I’ve known from day one. So if one rather has a focus on private life, pursuing an academic career and research might not be the way to recommend.

8、年輕醫(yī)生們如何知道醫(yī)院是否正在對他們進行良好的培訓？

How can a young doctor know if the hospital are giving them good training?

德國規(guī)定年輕醫(yī)生每年至少要與培訓負責人進行一次年度會談，這樣他們可以根據現(xiàn)狀適時調整培訓計劃。

對于我的住院醫(yī)生來說，我認為在非正式情況下跟我討論培訓進度更重要，這樣他們可以及時告訴我他們在培訓中最想學到的東西。同樣，我也可以實時把握他們的進度，并給他們合適的建議。

醫(yī)學生的培訓包括掌握各種技能、接觸不同病人，并在不同科室之間輪轉。年輕醫(yī)生應該盡早意識到，如果他們有機會去輪轉，他們會看到其他醫(yī)療機構的進修醫(yī)生和楷模醫(yī)生的培訓是如何進行的。如果你沒有去不同科室、不同領域輪轉的機會，你應該盡快跟你的科室主任反映。

In Germany, it is mandatory to have at least an annual talk with the person responsible for the training. So that young doctors can readjust their plans based on what they've been experiencing so far. For my residents, I think it is more important to get in touch with me on short notice to talk to me without a formal scenario as well, so they can tell me what they pursue as most important for their training. Likewise, I see how they are doing, and I recommend to them how to continue with their training.

Training in medicine involves certain skills and exposure to different patients and rotations through different departments. And I think young doctors should early on realize if they have the opportunity to rotate, they can see from other more advanced doctors and their role models how training is happening at a certain institution. And if no such rotation through different departments, through different areas of procedures happens, this is something that should be brought up in a discussion with the department head early on.

9、您和您的科室為年輕人才提供了哪些支持？是否有專門培養(yǎng)下一代的指導計劃？

What support for young talents do you and your klinik offer? Are there mentoring programs that specifically support the next generation?

慕尼黑大學醫(yī)學院有這類項目，我們會根據科研項目的先進程度，保障年輕人才的科研時間和資金。這個項目叫 F?FoLe，致力于支持年輕的研究人員。在我們腎內科也有類似的計劃，保障年輕人才在輪轉過程中的研究時間，讓年輕醫(yī)生有更多可支配的時間。同時也鼓勵他們到其他機構進行研究和輪轉。但這因人而異而且取決于經費，所需經費不能超出科室或大學給的范圍。年輕醫(yī)生還可以通過德國自然科學基金會（DFG）申請科研資金，我們提供其他方面的支持。

For our department at the Ludwig Maximilian University, we do have mentoring programs that support a protected time for research, depending on the stage of how far advanced the research program is. That’s called F?FoLe, which supports early on research. The other support specifically we in nephrology give to young talents a more protected time through rotations in either not so demanding rotations, which gives the doctors a little bit free time. And also the support to go for research, and rotations elsewhere. But that is on an individual basis and depends on grants, which are then not out of the department or the university. But the German research foundation, the DFG always offers research grants that can be applied for, and then we support them.

10、對于想要從事腎內科的年輕醫(yī)生/醫(yī)學生，您有什么建議？

What advice would you give to someone hoping to start a career in nephrology?

我會建議先了解清楚腎內科的日常臨床工作，臨床情況不同會存在很多差異。腎內科的門診服務包括一周六天的腎透析。意味著一周當中有六天需要為病人提供服務，如果你想把這當成終生職業(yè)，需要好好考慮這一點。如果選擇學術型道路，我會建議年輕醫(yī)生開拓自己的眼界和想法，目前還有很多懸而未決的問題都很值得我們研究。

我認為每個對腎臟病學感興趣的人都應該了解一下這些開放性問題，找到自己最感興趣的研究興趣，然后尋找一個專門從事這方面研究的機構。

I would recommend really taking a close look at how nephrology is practiced. There is quite a diversity depending on clinical settings. Ambulatory or nephrology in just outpatient practice involves dialysis, which is a 6-day week. You always have to treat patients 6 days a week which really is an important fact to take into account for a lifelong career. If looking at scientific nephrology, I think one should look at the different aspects - there are so many open questions that still deserve research.

And I think every person interested in nephrology should look at these open questions and see which specific research interest is important to her or to him, and then find an institution where particularly that research can be pursued.

11、您在國際上知名度很高，至今您最自豪的職業(yè)成就是什么，為什么？

You enjoy great international reputation. What is your proudest career achievement to date and why?

大約15年前，我申請了美國密歇根大學醫(yī)療中心腎臟移植中心主任一職。在眾多競聘者中，我收到了聘書，但我最終沒有接受。不過我很自豪能夠被密歇根大學這樣的知名機構認可，得到腎臟移植中心主任這個競爭激烈的職位。

Well, about 15 years back, I applied for a position at the University of Michigan Ann Arbor Medical Center as a transplant director. And actually among many competitors, I was offered the position which eventually I didn't take. But it made me very proud to be recognized by such a prestigious institution as the University of Michigan Ann Arbor for such a highly competitive position as a director in clinical renal transplantation.

12、在中國一些地區(qū)許多病人因為嚴格的疫情管控措施無法及時進行治療，比如腎透析、腎移植等。對于這種情況德國是如何解決的？

China is now facing another wave of pandemic. Many patients are not able to receive proper treatment like dialysis or renal transplantation in due time due to the strict COVID-regulations. How is this dilemma be addressed in Germany?

在第一輪疫情時，我們推遲了活體移植項目。因為當時我們誤以為只要疫情結束，隨時都能進行活體移植。

但是現(xiàn)在我們看到疫情還在持續(xù)，推遲任何手術都不是如此簡單的事，即使是活體捐贈。所以現(xiàn)在我們所有移植手術都照常運行。至于遺體捐獻項目我們從來沒有推遲過，因為遺體器官捐獻對手術時間有非常嚴格的要求。

從第一輪疫情我們意識到，即使是活體捐贈項目，延遲也是不可行的。所以從第二輪疫情起我們不再延遲移植手術。術前我們會確認捐獻者和受捐人都已接種新冠疫苗，并讓他們簽署知情同意書，了解術中的感染風險。對于透析患者來說，我們認為盡早接受移植手術后可以安心居家，比每周進行三次透析更好，后者一定程度上有感染新冠或其他病原體的風險。

Early on in the first wave, we postponed our living donation transplant program. because we felt that this could be done any time after the COVID pandemic. Now we see that the pandemic is going on and it's not so easy to postpone surgery even projects such as living related donation.

So now we continue with transplant surgery. We have never stopped the deceased donor program, because you take the kidney or if you don't take it, you will have to bury it with the donors. We learned from the first wave that if you're trying to postpone procedures such as living related donation, it does not work well.

So ever since the second wave and from then on, we have been continuing with our transplant programs. We make sure our donors and recipients are vaccinated. We get informed consent that they all understand the small but real risk of contracting infection. Yet we feel that especially for dialysis patients, having a transplant and being able to stay at home is an advantage compared to having to come to a dialysis unit 3 times a week, which goes along with a certain risk of infection with COVID and other agents.

13、新冠肺炎疫情現(xiàn)在是醫(yī)療領域最大挑戰(zhàn)之一，您認為這對您所在領域有何影響？

The COVID-19 pandemic is one of the biggest challenges facing modern healthcare. What impact do you see this having on the field of nephrology?

新冠疫情讓我們意識到我們必須保護患者免受感染，以及這在腎內科有多困難。一周要進行三次透析的病人每周都會在感染風險中暴露三次。如果透析室有疫情爆發(fā)將會是非常嚴重的問題。這也是當前大多數腎內科醫(yī)生面對的主要問題。

另一方面，正如我們剛剛討論過的一樣，我們意識到即使有新冠疫情，我們的治療都必須要繼續(xù)，比如透析、移植及腎病診斷等。

與其他擇期手術（如泌尿外科、骨科、眼科等）不同，腎內科的治療無法延期，這都是維系病人生命的必要條件。這一點對之前沒有意識到持續(xù)提供腎臟病治療重要性的同事們來說尤其明顯。所以我認為疫情也讓大家意識到腎內科的重要性。

COVID-19, made us realize how much we have to protect our patients from infections and how difficult that can be in renal units. Patients that have to come to dialysis 3 times a week are potentially exposed 3 times a week. If you have an outbreak of COVID in a dialysis unit, this is certainly a concern. This is a major practical problem that many nephrologists are dealing with these days.

On the other hand, as discussed earlier, we realized that treatment such as dialysis and transplantation and diagnosis of renal disease has to be continued despite the COVID pandemic. Unlike other fields as elective surgery in the urology, orthopedics, ophthalmology, treatment in nephrology must not be postponed, which is early on life-sustaining. And this is something that became very obvious to many colleagues who have not realized how crucial a constant availability of nephrology treatment is. So I think it helped the field to gain visibility with respect to the importance of nephrology.

14、假如您不從醫(yī)的話，您會從事什么行業(yè)？

What would you have been if you had not been a medical doctor?

因為我一直以來都對科學和生物學非常感興趣，我可能會想成為一名生物學家。隨著生物學的發(fā)展，我發(fā)現(xiàn)分子生物學也非常有意思。我不確定我會不會成為一名分子生物學家或從事其他領域，但是科學一定會是我職業(yè)生涯的重點。

Because I always found science very interesting and also found biology very interesting, I probably would have been a biologist. And now with the many advances in biology, I find molecular biology very interesting, but I'm not sure if I would have been a molecular biologist or in some other field, but science certainly would have been the focus of my professional life. 

15、除了醫(yī)學外，您還有什么興趣愛好？

What are your hobbies outside medicine?

根據不同季節(jié)我喜歡做不同的休閑運動，平時我喜歡跟高中時代的朋友們一起打壁球。到了相應的季節(jié)，滑雪也是非常美妙的運動，尤其是我所在的慕尼黑就在阿爾卑斯山腳下。如果我出國的話，我也偶爾玩一下水肺潛水。運動之余，我也喜歡欣賞表演藝術，我偶爾會看歌劇或者芭蕾舞表演，這些都是我在疫情封城期間錯過的事情。除此之外，我也喜歡去畫廊看藝術品，雖然我不是藝術方面的專家。

There are a few recreational sports independent of the season. I like to play squash with friends back from high school. And then depending on the season, skiing is a wonderful sport, especially here in Munich with the Alps so close by. And I also enjoy scuba diving once in a while if I go abroad.

Outside sports, I love performing arts, and I go to the opera or watch a ballet once in a while. And this is certainly something I missed during the lockdown. Aside from that, I enjoy going to galleries and looking at artwork, although I would not call myself an expert on arts.