#4 The perfect GP appointment. Episode 4

Agmoeszla Mastelarz

Monika Rachtan:
Dear all, welcome to another episode of the podcast "Patient First". Today's guest on my programme is one I've been very much looking forward to and I think many journalists have been too. The invitation to the programme was not easy, but my interviewee today is very well-known in the medical community. She should also be known to patients. I will therefore introduce you to Professor Agnieszka Mastalerz-Migas. Welcome, Professor.

Dr Agnieszka Mastalerz-Migas:
Good morning. Welcome.

Monika Rachtan:
Professor, thank you again for accepting the invitation to be part of this podcast because we are mainly talking about patients here. I think your presence here is extremely important, but I also understand that you are very busy, so this is a really special meeting.

Dr Agnieszka Mastalerz-Migas:
Some people think of me as a workaholic, although I repeat that this is not true. I simply enjoy working and am often very busy. I am very happy and thank you for inviting me, because without patients our work would be pointless.

Monika Rachtan:
Professor, before I talk about your affiliation and what you do, I would like to say that I always think of you as the mother of Polish family medicine. Last year, on the occasion of Mother's Day, I took the liberty of saying that about you when we met at the institute where we work. And now, again on Mother's Day, we have the opportunity to meet. Can I still say that?

Dr Agnieszka Mastalerz-Migas:
Of course, the years fly by quickly. This year my son started studying medicine, he is in his first year. Sometimes I look at young doctors as my children and try to support them. I won't be offended by such a term, but I hope no one takes it too literally.

Monika Rachtan:
I think, Madam Professor, now let me read. She is a specialist in family medicine, lectures at Wrocław Medical University, is a national consultant in this field and is president of the Polish Society of Family Medicine. May I now ask you, Professor, to say a few informal words?

Dr Agnieszka Mastalerz-Migas:
Indeed, I have many functions. Some of them overlap and complement each other, especially when it comes to training and educating doctors. I also have a private life - I have two children, an adult son and a 13-year-old daughter. I also try to work as a doctor, although I wish it took up more of my time. I am currently very busy and even work in a medical centre.

Monika Rachtan:
Professor, I would also like to ask you about your interests, as I follow your activities and I know that you are interested in sport.

Dr Agnieszka Mastalerz-Migas:
Sometimes yes, although I will admit that I have neglected this aspect in recent months. I've always tried to read and do sport. However, I have a promise to myself to get back to it. Now I have less time to read books, but I listen to a lot of audiobooks. I have a varied literary taste and read different genres. Listening to audiobooks is a form of relaxation for me and takes me to other worlds.

Monika Rachtan:
This is very popular with busy and young people. However, your professor travels a lot, so you probably spend a lot of time behind the wheel.

Dr Agnieszka Mastalerz-Migas:
Yes, I spend a lot of time behind the wheel because I like to travel by car. It gives me independence and a lot of kilometres driven. When travelling, I can keep track of things and listen to audiobooks at the same time.

Monika Rachtan:
Today we met mainly to talk about the role of primary care doctors, or family doctors. In my opinion, the family doctor can do a lot for the patient and many aspects of the patient's life depend on their decisions. Of course, the patient's involvement is most important, but the family doctor plays a key role. Is this the case in Poland? How would you describe a family doctor practising in our country?

Dr Agnieszka Mastalerz-Migas:
In part, yes. I have to start by clarifying the nomenclature, because there is some confusion with names in Poland. A family doctor is a specialist in family medicine who works in primary care. This specialisation prepares you for the comprehensive care of the family - both children and adults, up to the elderly. Our work includes the care of healthy patients, prevention and health education. However, many doctors work in primary care, not just family medicine specialists. Only about a third of the doctors in this area are family doctors. We have a shortage of staff, so we use anyone who has spare capacity. However, I would encourage you to seek out a wise and well-trained family doctor, as such doctors are extremely valuable and take comprehensive care of us.

Monika Rachtan:
First and foremost, the patient must want to find such a doctor and take the necessary time to search for one.

Dr Agnieszka Mastalerz-Migas:
Yes, he agrees. Sometimes listening to other patients' opinions can help you find a good doctor. However, it is fair to say that there are places where there is a shortage of doctors and the patient does not have that choice. We can change primary care facilities three times a year free of charge, but if there is a shortage of facilities in the area, the patient has a difficult choice.

Monika Rachtan:
Professor, if I may, I would still like to get back to work. Your professor is a national consultant in family medicine as of 19 February 2020. Is that the case?

Dr Agnieszka Mastalerz-Migas:
Yes, that's right. I became a national consultant about two weeks before the pandemic broke out.

Monika Rachtan:
I remember that day when I congratulated you on Facebook. Then came the pandemic and we often talked because those were difficult times. Has family medicine in Poland changed over these three years? What changes do you notice, Professor?

Dr Agnieszka Mastalerz-Migas:
In my opinion, family medicine in Poland has changed significantly. Of course, this is a process and not everyone from the outside sees it. I, being inside the system, have a different perspective. For example, the specialisation programme in family medicine has changed. Doctors entering training are now being trained according to a modern programme that includes a wider range of competencies, including ultrasound training, which was not there before. We have also slightly changed the way we do examinations, and the tests are now more clinical in nature. Overall, a lot has changed. Systemically, last year we started to reform primary care by introducing coordinated care, which is a more comprehensive model of care for patients with chronic conditions such as diabetes and hypertension. This is a process, and some facilities have already implemented this model and others are still doing so. For patients, this means many benefits. I think over the next few years we will consistently build this picture and make changes for the benefit of patients.

Monika Rachtan:
Professor, can you tell us about the work of a national consultant? What does your daily work look like? How does it affect patients?

Dr Agnieszka Mastalerz-Migas:
The national consultant has specific tasks according to the law. My main responsibility is the training of medical staff, especially in the field of specialisation. As chairperson of the National Examination Board, I am responsible for the training process of highly qualified medical professionals in the field of family medicine. Another important area is advising public administration bodies such as the Ministry of Health, the National Health Fund, the Medical Training Centre, the Postgraduate Medical Examination Centre, and the Agency for Health Technology Assessment. I make recommendations on conduct for doctors, as well as giving opinions on legislation and advising on health matters. My work mainly consists of training, drafting documents and providing support. Of course, the impact on specific patient decisions is indirect, but I try to make sure that the system runs smoothly and that patients have access to the best possible care.

Monika Rachtan:
I have the impression that you, Professor, are making sure that the system works properly and that patients receive the best possible care.

Dr Agnieszka Mastalerz-Migas:
Yes, I am trying to fulfil this role. I worked in primary care for many years, running my own clinic. I know the system both as a doctor, an academic and as a provider working with the National Health Fund. I saw many gaps and areas that needed improvement. When I became a national consultant and was tasked with leading a team to change primary care, I felt motivated because I could turn my thoughts and experience into new solutions that would improve the health system. I strive to ensure that patients have the best possible conditions and access to appropriate care.

Monika Rachtan:
Did the young doctor, when graduating and choosing her specialisation, see you as such a strong and active person, busy with many tasks? Did your professor foresee that she would find herself in such a position?

Dr Agnieszka Mastalerz-Migas:
Absolutely not. I didn't have a clear goal or expectation that I would take this position. I had always worked a lot and the additional responsibilities came gradually. As a member of the Wrocław team, after Professor Andrew's death, we had to continue his legacy and develop family medicine. It was a huge challenge for us, but we managed to become the strongest centre for family medicine in Poland. Over the years, I have observed various gaps and places for improvement, and now I am able to implement changes and influence the development of primary care. Choosing to specialise in family medicine was the right decision for me. Working as a family doctor is ideal for me because I love to interact and talk to patients. Although it is sometimes difficult, with experience you can deal with different situations and difficulties. If I had to choose again, I would choose the same specialisation.

Monika Rachtan:
Professor, you said that sometimes you are also a regular doctor. Can I see you in your office seeing patients?

Dr Agnieszka Mastalerz-Migas:
Yes, sometimes it is possible, although recently I have been very busy at work, especially in the last two or three months. I often have to be in Warsaw, so my direct contact with patients has been relatively low. However, I have regular patients that I have been taking care of for years, and I try to find time for them. We make individual appointments, they usually have direct contact with me and we meet when I am available. Especially during the holiday season and when other doctors are on holiday, my work becomes more intense. Although I don't want to say it too often, sometimes I have to work when other doctors are on holiday. Nevertheless, I try never to lose contact with my patients. As I mentioned before, I have many patients that I have been managing for a long time, and by working directly with them, I feel richer as a doctor. This work allows me to keep things in perspective. All the many administrative duties and appointments make me relax in the doctor's office and focus only on the patients. This is the time when I can switch off and dedicate myself to the patients. Sometimes, of course, I am accompanied by students or interns, but this is a very important moment for me that I wouldn't swap for anything else.

 


Monika Rachtan:
Professor, what should the ideal visit to a primary care doctor look like? I would like to see it through your eyes, Professor. Imagine that I come to you for the first time and say that I would like to become your patient. What would happen next?

Dr Agnieszka Mastalerz-Migas:
Is it about the first visit? First of all, we try to make this visit longer than the standard 15 minutes. Of course, a standard visit usually lasts 15 minutes, and sometimes it can be a little shorter, especially during the infection season when we have to compact the schedule a bit due to the high number of requests. However, for a primary care visit, especially if the patient comes in with chronic illnesses, we always ask them to bring the medical records they already have. We also book more time to find out more about the patient. This is such a one-off visit. I wouldn't call it a model visit, because there are many different visit models that depend on the patient's needs. For example, a visit related to an acute infection follows a fairly standard pattern - history, examination, recommendations - and is quite short. However, when a patient presents with multiple chronic diseases and requires more attention, 15 minutes is not enough time. In such cases, we use a new model of coordinated care, called comprehensive advice, which usually lasts half an hour.

Dr Agnieszka Mastalerz-Migas:
During this visit, we take a close look at the patient - what illnesses he or she has, what medications he or she is taking, whether he or she is achieving his or her therapeutic goals. We also review the results of tests and develop an individual medical care plan, i.e. we write down what should happen over the next few months. We may also recommend specialist consultations and give various advice. In this process, the coordinator plays a very important role in supporting the patient as part of coordinated care. The coordinator contacts the patient, reviews the care plan and helps to organise appointments with specialists.

Monika Rachtan:
I asked this earlier, but while we are on the subject of coordinators, please tell us what is the role of these professionals? They have to be very empathetic people who can work with both the patient and the doctor.

Dr Agnieszka Mastalerz-Migas:
Coordinator is a function that emerged in October 2021 in some establishments. However, there have been people in similar roles for a long time. The coordinator is responsible for coordinating the patient care process. This can be a person with a background in public health or a nurse. In fact, there is no restriction on the education that qualifies for this function. If you are interested, you can find out in your area if they are looking for a coordinator. As you said, this person must have a good rapport with people and be able to organise the work in such a way that they can supervise the movement of patients. Imagine having a group of dozens or even hundreds of patients who need to make appointments with different specialists, do different tests, receive complex advice. The coordinator has the task of ensuring that this process runs smoothly. This is certainly a person who has a lot of responsibility. For patients, the coordinator is an important support in contact with the medical system. He or she is like a good spirit who helps them decide where to go when, for example, they receive a referral to a cardiology clinic. There are probably several such clinics in Wrocław and you have to choose the right one, make a phone call and get an appointment. I imagine that the coordinator can provide this support. The doctor doesn't have time to remember all the phone numbers, it's impossible.

Dr Agnieszka Mastalerz-Migas:
I absolutely agree that the coordinator plays an important role in supporting the patient in their contact with the health system. The doctor does not have the time to do this. As I have already mentioned, in coordinated care we do not have to refer the patient to a specialist clinic because cardiologists, diabetologists, endocrinologists and allergists work directly with primary care. The coordinator directly arranges for the patient to see the specialist who is working with the coordinated care facility. We do not have to wait in long queues; the appointment is scheduled in a relatively short time. Of course, there is also a coordinator who receives information from us about patients referred to specialists. At my facility, we have a multi-specialist facility where appointments are scheduled on a rolling basis. There are no rigid days, for example, that our patients are only seen on Thursdays. Appointments are flexibly arranged according to availability in the doctor's schedule.

Monika Rachtan:
Professor, can every patient benefit from coordinated care? Is it implemented in all primary care centres?

Dr Agnieszka Mastalerz-Migas:
Unfortunately, not all patients can benefit from coordinated care. First of all, one of the conditions for benefiting from this care is an appropriate diagnosis of the disease. There are currently four diagnostic and therapeutic pathways, i.e. four areas in which coordinated care is available. These are cardiology, diabetology, endocrinology and allergology. In addition, this applies to selected disease entities. Therefore, you can benefit from coordinated care if you have a diagnosis such as diabetes, hypertension, heart failure, ischaemic heart disease, atrial fibrillation, hypothyroidism, thyroid nodules, asthma or COPD. If we have this diagnosis, we can benefit from coordinated care. Is it being implemented in all facilities? Not yet in all, because the process of implementing coordinated care is ongoing. Every month, more facilities join the programme by signing annexes to contracts for primary care services. The number of facilities implementing coordinated care is growing. In Lower Silesia about one third of the entities, i.e. about 150 facilities, are already implementing coordinated care, and in the whole country there are already almost 1300 entities. It is worth asking your institution whether it offers coordinated care.

Dr Agnieszka Mastalerz-Migas:
There is also a dedicated websitewww.koordynowana.pl dedicated to coordinated care, where you can search for facilities in your city or region that offer such care.

Monika Rachtan:
Professor, I would still like to ask you about the disease entities you mentioned earlier. I wonder if patients have a good understanding of what is involved. For example, if someone has not yet been diagnosed with diabetes, do they need to see a diabetologist or a primary care physician first?

Dr Agnieszka Mastalerz-Migas:
No, you do not need to be referred to a diabetologist to be diagnosed with diabetes. The diagnosis of diabetes is simple and has long been carried out in primary care by most doctors. It only requires measuring fasting blood sugar levels twice. It is not a secret test and there is no need for a referral to a diabetologist. That said, the patient must have a diagnosis to be covered by coordinated care. If the patient needs tests to establish a diagnosis, then of course these can be done. There is no problem if he or she presents, for example, as part of a preventive programme such as prevention for the over-40s. If the patient has a checkup or symptoms suggestive of the disease, this may also be a reason for testing. Diabetes does not always give symptoms, but hypertension, for example, can manifest as recurrent headaches.

Dr Agnieszka Mastalerz-Migas:
If a patient presents with symptoms or test results, the doctor initiates a course of action. He or she may order tests to establish a diagnosis and, if the diagnosis is confirmed, the patient may receive comprehensive care and benefit from dietary advice, specialist consultations and additional diagnostic tests. He or she is given a care plan that sets out what will happen in the coming months. The doctor determines whether the patient needs education, especially if the disease is a newly diagnosed chronic illness. Patients usually want to learn more about their disease, how to measure blood pressure, blood sugar and other health monitoring parameters. In caring for a patient with a chronic disease, there are many activities, such as taking care of health and preventing complications.

Monika Rachtan:
In the past, many patients treated the primary care doctor as an intermediary to get a prescription or a referral to a specialist. But I would like to convince our listeners, knowing how important the role of the primary care doctor is, that it is worth visiting, talking to, consulting. Even if we feel well, a check-up in our 30s or 40s can help us maintain our health in the future.

Dr Agnieszka Mastalerz-Migas:
I agree completely. In primary care, patients have access to a range of diagnostic services and comprehensive care. We should abandon the idea that the primary care doctor is only there to make referrals to specialist clinics. This is also convenient for patients as they do not have to wait in long queues to see specialists. However, it is important to know what benefits we are entitled to. We will soon be publishing a guide for patients together with the Patient Ombudsman, which will help you understand how to prepare for an appointment and how to make it easier for you to use the health care system. I encourage you to read it and look at GPs as health professionals who care not only about treatment, but also about prevention.

Dr Agnieszka Mastalerz-Migas:
It is important that illnesses occur as late as possible and that we enjoy good health for as long as possible. Even when we already have a chronic disease, taking care of ourselves is important because the disease can take different courses. With diabetes, for example, you can live a long and healthy life by taking the right medication and following healthy lifestyle recommendations. But it can also be the other way around, we can have complications such as a heart attack, stroke or diabetes-related foot ulcers. Therefore, it is very important that we take care of our own health, and our primary care physician is there to support us in this and provide optimal care.

Monika Rachtan:
I know that your professor mentioned that the relationship between patient and doctor is not always the best. Could you say what the patient can do to improve this relationship?

Dr Agnieszka Mastalerz-Migas:
This question is difficult because interpersonal relationships in general have deteriorated. The pandemic has exacerbated this, but you could already see that patients and doctors are standing on two sides of the barricade. This is not good, so we should remember that two people are meeting in the first place. I try to always see the person, even if they are upset or annoyed. Often these are situations where the patient has already had problems with the healthcare system. It is important to understand what is behind this. However, it is also important for the patient to see the doctor as a human being, as the doctor may also be tired or have different problems. Let's try to be polite and kind, even if it is sometimes difficult. A smile and kindness do not cost us much. Empathy and patience are also very important. These are qualities that are very important in the work of a GP. The emotions of the patient and the doctor can affect the relationship, but long-term cooperation with the patient benefits the relationship. However, it is worth remembering that situations vary, and we may not always know the patient for a long time. It all depends on our own understanding and ability to empathise.

Monika Rachtan:
Many of my questions have already been answered by the professor, which I wanted to ask. But that is very good. Professor, in every programme where I meet my experts, they all talk about the need to be human. I think that's amazing. I think that's going to be the motto of this podcast in general, because every expert that has come on this show so far has said that both the doctor and the patient should be human. And I thought to myself when the professor said about doctors' mistakes, which is just the wrong prescription. Well, it happens to me many times, for example, when I call an expert and I want to invite him to a programme, to a podcast, to give an interview, for example, I get the affiliation wrong. Well, because you have very complicated affiliations and it is really very rare that someone doesn't shout. For that, people usually give me a cultural remark. But you also know that I work with very cultured people, so that's the way it is. And when someone gives me a cultural remark, I apologise and we move on. It's the same in the shop when someone gives me bad change.

Monika Rachtan:
This is normal. And we look at these errors in such situations in a completely different way than we look at a badly written prescription. This is where patients often come up big with the doctor, because it is a very normal situation when a tired doctor who has had 30 patients, for example, gets one digit wrong in a patient's peseload, right?

Dr Agnieszka Mastalerz-Migas:
Yes, here we should indeed have a certain tolerance for human error. Of course, since there are prescriptions, things like a mistake in the peselas probably don't happen, although sometimes we also write paper prescriptions for various reasons. Sometimes the internet, for example, is missing. But I think that the biggest area of conflict is, unfortunately, problems with reimbursement and the fact that a prescription is not even a mistake, but is a specific medical decision related to the fact that the patient is not entitled to a reimbursed medicine, and expectations are different. And this is a huge area of conflict. I very much hope that one day we will live to see a time when reimbursement will not be a problem for doctors and will not cause these conflicts, because as far back as I can remember, most of the conflicts relating to prescriptions were connected with the fact that the information that a patient had disease X could not be given a drug reimbursed for that disease. He expected to get it. Sometimes he will also hear in the pharmacy that here is a possible reimbursement and this reimbursement is not there. And these are such virtually innocent sins, you could say, because we have no influence on how these regulations are shaped, but these are frequent situations and there could be none.

Dr Agnieszka Mastalerz-Migas:
But this is the legal situation we have.


Monika Rachtan:
The professor wanted it to be said very strongly once again, because we are communicating to patients and I think that it is also our task to improve this relationship between the patient and the doctor, that it is not the doctor's bad will that he does not write this reimbursed prescription, that it is not the case that if he writes it, he will have less of something, and if he does not write it, he will have more of something. It's just that this doctor is functioning within some system, he has checks from the National Health Fund and he is really accountable to the payer. Yes. And a lot can happen if he makes that decision irresponsibly.

Dr Agnieszka Mastalerz-Migas:
That is exactly right. Here, I would like to emphasise that doctors should not be seen as ill-willed and doing something to spite patients, because that is not the case. There are, quite simply, specific regulations, and you must be aware that a doctor bears the very strong financial consequences of failing to comply with these regulations, because if a doctor incorrectly determines reimbursement and issues a prescription for a reimbursed medicine to a patient, and the patient is not entitled to that reimbursement, then, upon inspection, the doctor pays this money, together with an additional fine to the National Health Fund, despite the fact that he does not seem to have benefited in any way from this. However, it is the doctor who pays for this mistake and for the benefit that the patient has in fact obtained, because the patient received a reimbursed medicine in a pharmacy, and sometimes these amounts are very high, because you are probably not aware of this, but sometimes a medicine that costs 3 PLN in a pharmacy actually costs, for example, 2 000. And unfortunately the doctor's mistake costs him the difference.

Monika Rachtan:
This is very important information, and I think that patients should remember it. Professor, I would like to come back to the end of our meeting, because we talked about the fact that you work a lot. I would like to mention all the functions that you perform, but you are also a lecturer. You educate doctors, patients, you are the president of the Polish Society of Family Medicine, you are a national consultant in family medicine. What are your plans once all these terms are over? Will there be time for rest? Will the professor finally read books rather than listen to them? Or will she go on holiday and not take calls from journalists for a year?

Dr Agnieszka Mastalerz-Migas:
For the time being, I am not at all defining such a time azimuth that one day all these functions will end. Of course, some of these functions have a term of office, others do not, so everything flows. And here I may indeed be in a different situation in a few years' time than I am now. I don't plan for it, I don't define it. I think, knowing my character, I will always have something to do, if only I look at my clinic, which is growing. At the moment it's three facilities. It really is. There's really a lot of that benefits management work itself, I don't think I'll ever run out of that work. I'm always a doctor, so maybe there will come a time when I'll actually have a lot of time to work in the practice and I'll have a lot more availability for patients. Well, I don't want it to sound bad, but maybe I'm still a bit too young to be thinking about retirement. But as for rest, I try, I try to keep some rules, but at least some minimum hygiene, lifestyle. Sometimes I take a micro-rest, and sometimes I take a few days off, because there is a lot of work.

Dr Agnieszka Mastalerz-Migas:
I, too, cannot be a doctor who simultaneously carries out such a terrible plundering of my own body and my own health, because this will probably come back to haunt me sooner or later. So here I can also appeal to those of you who work a lot to take sometimes shorter, sometimes longer breaks. I don't think there are irreplaceable people and the world will survive for a week or two without us. And I have to say this to myself really often.

Monika Rachtan:
I think the professor can be such an indispensable person and this is where the volume of work comes from.

Dr Agnieszka Mastalerz-Migas:
But you have to, you have to think about rest and indeed physical activity too. I, for one, promise to get back to it.

Monika Rachtan:
Professor, the patron of our podcast is the Institute for Patients' Rights and Education, which talks a lot about the humanisation of medicine. I think we have already talked a lot about this humanisation, but I would like to ask you, Professor, from the perspective of a national consultant, the president of the PMR, but also from the perspective of an ordinary doctor who practices in a surgery. What does the concept of humanising medicine mean to you, Professor?

Dr Agnieszka Mastalerz-Migas:
This is a difficult question to flesh out in such a short statement, but difficult and easy. Medicine is a human science. This is important to remember. What does it mean that at the centre of this science is the human being? Of course, we can surround medicine with very modern technology, very modern science, the latest medical knowledge, but we must not forget that the centre of our interest is the human being. And this technology, science and knowledge are tools for us, they are tools for contact, doctor-patient contact, that is, human-to-human contact. And it is very important that, especially nowadays, we do not lose this, we do not forget about it, because if we forget, it will start to destroy such a black scenario, which sometimes resounds from various statements, that here we will be replaced by artificial intelligence and so on. We will not be replaced by artificial intelligence, as long as we remember that in medicine this human-to-human contact is the key of our work.

Monika Rachtan:
Professor, thank you very much for your answer and now I will move on to the last item on the agenda, which is these four short questions from the Facebook groups. I'm going to ask for 30-second answers and we are absolutely not making any diagnoses here, we just want more to show patients which way to go. The first question will read, to quote. "It's difficult for me because I'm afraid of what my family will say. Lately I've had a problem with wanting to live. I'm constantly tired, angry and want to cry. I suspect depression, but I don't want to go straight to a psychiatrist. Everyone will think I'm crazy. Can the family doctor help me somehow by giving me medication or sending me to a psychologist? Is it even worth talking to him about it?"

Dr Agnieszka Mastalerz-Migas:
As worthwhile as it may be. You need to see your GP and he or she will certainly provide support. GPs treat depression and care for patients, so I would encourage you to contact your doctor.

Monika Rachtan:
Second question: what is the difference between a family doctor and a paediatrician? We have a paediatrician doctor at my GP surgery, but there are not always appointments for him when there is this problem. In the registration they suggest me with my child with a family doctor. Is this ok or does he also know about children?

Dr Agnieszka Mastalerz-Migas:
As much as possible it is ok. A family doctor knows about children. As I mentioned at the beginning of the interview, specialising in family medicine gives you the basis for comprehensive care for the whole family, so both children, adults, the elderly. It is safe to use the care of a family doctor, also for children.

Monika Rachtan:
Madam Professor, I think it's more of a claiming patient, but I think you can certainly handle it. This year it's been something of an apogee. They got sick twice a month, each time a visit to the doctor and syrup, nasal drops, and in a while a new illness L4. Well, and I wanted to add an antibiotic, but the doctor told me that there is no basis for how to cope in such a situation, to persist, After all, it is me who is ill, not him.

Dr Agnieszka Mastalerz-Migas:
Well I think patients overestimate antibiotics and their effectiveness in treating illnesses, mostly respiratory. Here, please remember that it is the doctor who decides, assesses the state of health and really, in 90 per cent of cases, an antibiotic is not necessary, so we definitely overuse antibiotics. So here, without knowing the patient's specific medical history, it is difficult for me to make such a definite statement. On the other hand, antibiotics should certainly not be decided at the patient's request, but should be the doctor's decision.

Monika Rachtan:
And your professor one last question. I am pregnant and I have been to my GP recently because I wanted to get referrals for basic tests. I have a private gynaecologist and I have to pay for the tests. My GP told me that it's a good idea to get vaccinated for whooping cough during pregnancy. The gynaecologist didn't say anything to me about this. Is it necessary and does this family doctor know? Should I go to the gynaecologist to have this vaccination?

Dr Agnieszka Mastalerz-Migas:
Vaccination against whooping cough is one of the very important vaccinations recommended during pregnancy. There are not many of these vaccinations in pregnancy, but vaccination against whooping cough is one of them. We vaccinate at the end of pregnancy, that is after the 27th week, preferably between the 27th and 32nd or 34th week of pregnancy at the latest, because it is about protecting the newborn against whooping cough. So as much as possible, the family doctor recommended well. I am proud of this doctor, because it means that he is well educated. Some gynaecologists, even more and more, are also becoming educated and are also recommending these vaccinations. Also, I absolutely here encourage vaccination precisely in this last trimester of pregnancy. And I would also add that it is worth remembering, when pregnancy is in flu season, to vaccinate against flu too.

Monika Rachtan:
Thank you very much, Professor, for answering patients' questions. I will remind you that you can ask such questions on social media, right on the pages of the podcast. And here, I will try to pass on these questions to our experts so that we can together answer the patients' needs. Professor, it was a great pleasure to have you on my programme.

Dr Agnieszka Mastalerz-Migas:
I, too, thank you very much for the invitation and recommend myself for the future.

Monika Rachtan:
Thank you very much. Thank you for your attention.

Dr Agnieszka Mastalerz-Migas:
Thank you.

Monika Rachtan:
Excellent. Professor, I didn't ask all the questions because you answered them in advance before I had time to read them. So thank you very much again and feel free to send in your questions. Thank you.