This time, we have prepared an article for you in our Personalities in Medicine column with MUDr. Mark Dvořák. An emergency medicine doctor who spreads awareness all over the Czech Instagram. In addition to medicine, he also practices MMA in his spare time. According to him, no harm can be done with first aid.
MUDr. Marek Dvořák, Ph.D. MBA
He graduated from the 2nd Faculty of Medicine of the Charles University, works at the ground and air rescue service in Hradec Králové and at the Emergency Department of the Motol Hospital. According to him, emergency medicine is the best choice for a doctor.
Why did you choose medicine and paramedics?
Medicine and ambulance, hmm, I had it somehow connected when I wanted to start working as a doctor, so under the term doctor I imagined a doctor of emergency medicine. I don't really have much else to do with it so far and it seems like the best field you can do in medicine. Because when you say doctor, I imagine someone who lives somewhere, and when some mega trouble happens, then everyone goes to call that doctor and at three in the morning they pull him out to the sick person to help him, and that's always me it was tempting. I was kind of inclined towards action stuff, first I wanted to be a policeman and when I kind of converted, I started to want to be a doctor. And my classmates from elementary school still make fun of me that I only have 150 left, so I still haven't knocked out the firemen. But I don't plan to change just yet. So emergency medicine is what I enjoy and it's fulfilling and I find it really nice. It is a field that intersects with all spectrums of medicine. Bad colleagues claim that we can't do anything properly, and we claim that we can sort of do everything, to the point of keeping a person alive. And it doesn't matter if it's a newborn a minute after birth or a person at the end of life who has a lot of experience.
I like what I defined, that you can see the result right away. I'm quite impatient like that and it's quite action-packed, the spectrum of those patients is very different and it's not stereotypical and it's quite fun and varied.
Would you recommend medics and young doctors to go to work in the emergency room? Why do you think emergency medicine is the best choice for a doctor?
Yes, definitely yes. Because it seems to me to be the most interesting field that a doctor can do after school, or in medicine in general.
Who do you think this job is not suitable for?
It is probably not suitable for people who want to have working hours from eight to fourteen, who want to have a regular schedule. Maybe not for people who know in advance that they easily succumb to stress, so they probably shouldn't focus on this, because you often have to make decisions very quickly and the situations are often very tense. But I think there's a lot to learn from that too. That the reduction in the amount of stress you are under somehow comes with the more you do it. I would also probably be very stressed if I had to repair my knee or hip.
Do you have any training in how to manage stress or make quick decisions?
Yes, as an ambulance yes, but that comes more with how long you work and how dedicated you are to it. And it's the same as in medicine, you don't immediately start flying in a helicopter and you're not in the position of head of the emergency department, but somehow you gradually work your way through it and get used to the responsibility and decision-making before you're there all alone with that patient.
-min.jpg)
What do you enjoy the most? Work in the emergency room, trips with a helicopter or an ambulance?
Everything has something in it, you will find something that you really enjoy. Of course, I like the helicopter the most. But surprisingly, I don't like the helicopter as such. There are a lot of people here who love flying for its own sake, but that doesn't appeal to me that much. It seems like a normal means of transport to me and I usually don't take that flight. Although sometimes it's beautiful and interesting in terms of landscape and sunshine, sunset, romance and so on, but I don't find the medium interesting in itself. I find the spectrum of patients that I see thanks to the helicopter interesting, because that is a cross-section of the real urgent raw medicine, that in fact, for that one air service, you can get to things that people on the ground can get to in a year. The intensity of serious conditions is significantly different. Of course, you can find a lot of interesting things in the emergency room, you do things there that you don't do in the emergency room, and there is a continuity of that care. You set up some blood tests, imaging tests, you talk to the colleagues there, you find out what the next step is, whereas in the ambulance you usually spend an hour with the person, not even, and mostly it's about basically getting them in and keeping them alive very similar progresses. In the hospital, you can do anything in the emergency room, from setting up central venous access, intensive access, lab evaluation, and so on. That's good too.
When is a helicopter flown instead of an ambulance? Is there a limit?
This is decided by the medical operation center, which has indication criteria for this. In short, this means that the helicopter flies when it has some benefit. Whether it is temporal, when the patient will be in the hospital earlier or he will be provided with care earlier when needed, or some other, for example logistical. Typically, these are accidents in the mountains, when it would be very difficult for someone to get there, so a helicopter flies there. And then we have some equipment that is unique right here in Hradec, such as blood. No other crew has those, so if the person needs a blood transfusion, for example, we fly there.
So you're giving the transfusion right in the helicopter?
Right on the road. We have 0 negative whole blood and this is given to the person at the scene of the accident if indicated.
And are there any no-fly areas?
Well, for example around the city, around Hradec, it has no meaning. Because before we launch the helicopter, before we fly three hundred meters, the ambulance will definitely be there faster and the person will be in the hospital faster. We are still limited by the weather, it is mostly fog. When there is heavy fog, we cannot fly for safety reasons. There are more reasons why we can't fly. We have a set rule that is strictly followed and that is that we do a quick assessment before the flight to see if it is safe. The pilot will have his say, he has the main say in this. But even we can say when these are borderline situations, when the pilot says "yeah, we could try," and we say "but there's crews on the ground, that person would have the benefit of five minutes, that's not a level of tolerable risk for us " so we don't fly. And at the same time, during the flight, anyone from the crew (there are three of us) says that they don't like it, that they are afraid, so it is not discussed and we turn around, the event is cancelled. Mostly it's the pilot and we don't discuss. But I can say that from behind too.
.jpg)
You've said in several interviews that you have ADHD, is that a self-diagnosis?
No, look, I'm answering three texts right now, that's terrible. I did not diagnose. In fifth grade psychiatry class they told us about it and I listened to it and thought "dude, I've got it". So I told the teacher and he told me "no, you don't have that, all the psychiatric diagnoses, if I tell you, you will find them on yourself". And I told him: "No, I really have it, I meet the criteria", so he gave me tests and then said "you guys, you really have it". And I actually had it diagnosed in the fifth year of medicine. So I guess I have a mild form, and the psychiatrist told me that if I had ADHD, I wouldn't be in the fifth year of medicine, but in the end he explained it to me by saying that I compensate with good intelligence and memory. That if I sit down for a while to learn, I remember most of it.
What is the strangest story you have experienced at work?
But you know, there are a lot of funny things in medicine, but they're mostly inside jokes that aren't very reproducible, and it's often the magic of the moment. I thought of one now, but it's already been shot a lot. A guy called us that someone was lying unconscious on the street in Hradec. So we went there and kept looking for that person. There were cops, firemen, even I think two ambulances, and we drove back and forth. Then the caller was called and he said "well, keep driving around him" and he was already so aggressive, why don't we help him, that he's still lying there and we don't notice him. And then it turned out to be a puddle. He was looking at the pool from the window and thought someone was lying there.
Which trip did you enjoy the most?
I'm always happy when it works out. And I get the greatest joy when I think it won't happen and it eventually does. And they are, for example, a successful resuscitation or when you really help someone. Overall happy with a job well done. I think there are relatively few such "wow" effects, that something really happens, even in a career. That was one of the first outings, when I was still in training, we pulled a little girl out of the cesspool with circulatory arrest and she is completely fine. Traumatic circulatory arrest is said to have a one in a thousand chance of survival. So I think I have a few patients who have survived traumatic arrest and are completely fine, so that's great. Now we recently had a girl fall out of a window in Prague who was talking to us when we got there and then stopped. She had a tension pneumothorax, we did a thoracostomy and promptly resolved the reversible cause and her circulation was restored and she woke up in the hospital fine.
How many people return to you after trips?
It's not much. And it's probably for one simple reason, that Dr. Dvořák doesn't take care of those people himself, but dozens of people take care of them. And it is difficult to determine who really saved your life, whether it was the operator, the witness or the ambulance team. And I understand that people will not go to thank eighty health workers. I now have an advantage in Instagram. I'm probably more visible, so I'm lucky that people can find me relatively easily, and they're more likely to remember me. And maybe they will write to me and thank me. And I'm quite followed by mothers on maternity leave or with small children, and quite often such funny situations arise now when we fly somewhere and they say "I'm so stupid, I read it on your Instagram and it happened anyway." Now we were with a burnt child, a very typical mechanism, when the brother poured coffee or some hot water on the small child through the tablecloth. And the mother said: "Jesus, I was completely afraid that you would arrive. I read it there and the same thing happened.” Fortunately, the child had minor burns and turned out well, so the situation was quite funny in the end. So I think the people are grateful, it just rarely makes it to the ambulance, but come on.
-min.jpg)
When your pager rings, what do you hope isn't the case?
I have to say that now I don't even look at it much and go straight to the helicopter. I'm glad I'm in a situation where the takeoff no longer gets my heart rate up. My approach is to go to the patient and do what I can. But I used to think I didn't want to resuscitate a baby or some really nasty mess. And now I think I don't have anything that bothers me a lot. Of course, there are takeoffs that you don't want to experience. And they are very unpleasant. These are, for example, attacks on colleagues and their family members or, God forbid, on your family members. I think this is such a nightmare for all health professionals. And I don't even nurse my family. I try, when something happens to my loved ones, to take them to a doctor I trust and "here you go and do it". Because you might underestimate it a lot, that's what happened to our daughter. We are both medical professionals and we thought that her asthma attack was still in progress, and then when we thought that it was probably not in progress, we took her to the emergency room to have a doctor look at her, and you they completely scolded us that it was already blue, that we were crazy.
Do you like adrenaline?
As in taste? Or what application form? Yes, I do, but in a healthy, athletic way.
Do you have a demanding and stressful job, do you have any advice for fellow doctors on how not to burn out? Have you ever felt burnt out?
I had once when I was really overworked. I realized this when we were in the emergency room at some three in the morning and some grandma was telling me how she takes her blood pressure at home and the second reading is already 170 and the third reading is 185 and I was totally like, "Oh my god, I don't want to listen to this". I was unempathetic towards her and it struck me that I didn't want this after all. I went into the job with something and this is over. So I took some work off and took it easy and I think I've kind of gotten over it and now I'm not completely burnt out. And advice on how not to burn out? I don't know, I think it's probably important to be professional. You may have a lot of worries around you, but the patient shouldn't know it on you, and that can be done. If you look at American paramedics, I'm not saying that they are a role model, but at least when they go somewhere, everything is "fucking", "fucking weather", "fucking car", but once they get to the patient, everything is sunny , they introduce themselves to him, they smile at him, they listen to him and the patient certainly doesn't know anything. And I think that's the way. When you call the client line at the bank, the person doesn't start telling you "yeah, I'm busy today, our internet banking doesn't work", but he's mega professional and will do something. I think this should be in medicine too, and I try to apply it.
And how not to take the work home? Don't you then think about trips at home in bed?
Not much, and if it is, then mostly not with a negative emotion. It's because I'm already thinking about the exit and I'm thinking about how to make it as good as possible. That has always paid off for me. Even if there are doubts, I always say to myself: "Okay, now if my father was lying here, what would I want someone to do for him". And I will do it. What ever it takes. Even if I should then be scolded as sometimes it is expensive and above standard. I always have to justify in my head why I'm doing it, and I'm going to do it, and that's the way I see it. Because then there are no more doubts. This is exactly how I would be lying in that bed if I had chosen the second option, thinking, “Couldn't something have been done better? Or otherwise?" But so far I've always managed to do it the best I could at the time, so I'll defend it to myself. And when someone says something, I tell them that it was the best thing I could think of for that person at that moment. I'm not saying anyone couldn't do it better. But I couldn't think of a better idea at the time. And I can live quite well with that.
Do you have time for family?
Well, that's not exactly optimal. I'm trying to put it together somehow. Children recognize me when I come home, that's fine (laughs).
How can I, as a doctor, best educate myself in first aid? Where would you recommend doctors get and update information?
I think definitely good ALS, ATLS courses if we are talking about that emergency medicine. And then, if you enjoy it, just do it and educate yourself in your specialty. Of course, a psychiatrist will probably be educated differently in emergency medicine, and a doctor who wants to drive an ambulance will be different. It probably can't be called that in general. But I would recommend the ALS course to anyone who wants to do just a little bit of it. And then definitely the guideline, recommended procedures for ERC resuscitation.
Thank you very much to the doctor for the interview.
The interview was prepared for you by Filip and Jana.
