How does stress damage a woman's heart? Episode 77

Monika Rachtan
Hi Monika Rachtan, a very warm welcome to the next episode of Po Pierwsze Pacjent. Poles don't like going to the doctor. They say that they won't cut out cancer because it will spread, or that they won't do preventive tests because the doctor will find something in them. Today about why it's important for women to take care of their heart, but also the health of their whole body. I'll be talking to Agnieszka Graczyk Szuster, MD, of medical sciences. Good morning, and welcome. Hi. Agnieszka, you are a cardiologist, but you are first and foremost a woman in medicine and you work hard to make us girls healthier. You educate patients, the public and doctors too, right?

Agnieszka Graczyk Szuster
Yes. Apart from my work, which is strictly clinical, i.e. working with patients, my additional hobby, and my feeling that this is important, is education and also encouraging patients to undergo preventive examinations, because I see that many deaths could indeed be absolutely avoided. Whereas we are as a society. We were talking a moment ago, still unprepared for this. And when it comes to cardiovascular disease, because of my background, I have to say that we women perhaps do not know this. We die more often from heart attacks and strokes than men. According to the 2019 statistics from the Central Statistical Office, just under 50% women died of cardiovascular disease and men in comparison just under 40%. So see, heart attacks used to be associated with men, but it is us women who are more likely to die of cardiovascular disease. And similarly with pranks, for example. Now it's the month of October and you really have to nail the examination. I have already had a mammogram and am now waiting for the result. However, when it comes to such total mortality, the data say that 4% of the population dies from breast cancer, which is the most common in our women, while 25% of women die from heart attacks.

Monika Rachtan
What is the reason for this? That women are more likely to develop these cardiovascular diseases? Is it that it is often said that it is just stress, that stress makes us sicker with heart disease? Is this actually the case, or are we just forgetting to take care of ourselves?

Agnieszka Graczyk Szuster
This is very multifactorial and I will try to answer this question in a few steps. Firstly, we women get sick slightly later than men with cardiovascular disease. We usually start to get ill around the menopausal period, At the time when our menstruation actually ends or has already ended. Men in their 40s, we usually in our 50s. But of course there are women who are 30 35 and also have heart attacks, because again it depends on other risk factors. But in the recent guidelines, as you mentioned, this so-called stress that goes on in our lives, the recent guidelines of the Polish Cardiac Society, and actually in the recent guidelines of the European Society of Cardiology, there have already appeared such additional risk factors that increase the risk of cardiovascular disease, especially in women. And one of them is chronic stress. In addition, of course, to factors such as depressive-anxiety disorders or exclusion syndromes, loneliness, for example, these are things that also influence the increased incidence of cardiovascular disease, unfortunately. When comparing two groups of men and women who had similar levels of stress, women were much more likely to suffer from various types of heart disease. Compared to men, stress has a much greater impact on women than on men, and we are more predisposed to cardiovascular disease. On the other hand, I also think it is good for us to remember to perform. Anyway, when it comes to heart disease in women. We, within our Polish Cardiac Society, also have a special, dedicated section on heart disease in women, because we women, and this is scientific data from many centres, from many countries, get sick slightly differently. As I said, when it comes to myocardial infarctions, we have them a little later, but also, as I also said in the first entry.

Monika Rachtan
But it's all coming together for us. Well, see, we have a woman who is, let's say, 45 years old. She's still working for the company she used to work for, she's got a lot of stress there, well, because she's already at the age when someone better than her can come along, she's already feeling a bit threatened, or, for example, she's in a managerial position and has a lot of responsibility for her work. On the other hand, menstruation disappears, menopause appears, so it's stressful for every girl, whether she's 45, or 47, or 50, and then there's the children, the children leave home, go away to university, and what you said, a bit of loneliness, a bit of stress. This is where this menopause changes our whole body. And just comes that moment when these cardiovascular problems can start?

Agnieszka Graczyk Szuster
Definitely if we took the women who come to my practice, I have a very large group of girls between 45 and 55. So those are the people who. That's exactly right. Empty nest syndrome Menopause. Often the partner has left for a younger one and unfortunately also often downsizing This also happens And these girls are suddenly faced with various health challenges. Most often they come with hypertension, because until we still have menstruation, which means estrogen is produced by the ovary we have protection. Yes, that is why we have this 10 years later incidence of cardiovascular disease than men. But the moment the ovary is no longer producing oestrogens, all of a sudden you get, for example, hypertension, Because oestrogens caused different mechanisms, of course, for example, the dilation of the arteries, and this pressure was relatively low And all the girls who come to me say Gosh, I've been 90 over 60 all my life, and now I'm 160. What happened? Well, unfortunately it's just the lack of oestrogen, but it's added to that of course by stress. Chronic stress, for example. Let's take it one step at a time, what can produce chronically elevated blood pressure in our body?

Agnieszka Graczyk Szuster
Increased heart rate. Chronically elevated blood pressure, of course, can mean a risk of stroke, heart attack in various situations. Chronic stress itself also causes such chronic inflammation in the body, which, for example, causes faster formation of atherosclerotic plaques of those on the inside of the vessel. Here again, it is much worse in women. We are more prone to chronic stress, to chronic inflammation and to faster formation of atherosclerotic plaques. In our cardiology, for example, stress in women already in the perimenopausal period after menopause 55+ can even induce something like this, which is called Tacotsubo syndrome. Broken heart syndrome is the colloquial name for it and it is very common in women just 55 60 plus under very severe stress. And this stress can involve the stress of a spouse or someone in the family. I personally took in a lady whose cat died and she also had Tacotsubo syndrome. A personal elderly colleague of mine had to repair the roof on her property during a windstorm and also, unfortunately, later admitted herself to the ward because she is also a cardiologist with the syndrome. Yes, because these are the kind of syndromes that mimic a heart attack but are not one.

Agnieszka Graczyk Szuster
And we women are definitely more susceptible and mainly it actually occurs in us as a result of this strong emotional stress. Fortunately, usually these symptoms withdraw within a few weeks, a few months, but they manifest themselves very much like a heart attack or an imaginary heart attack. No, I wouldn't say so much. On the other hand, something that mimics a myocardial infarction, because these are chest pains, when such a patient arrives in the ED. We have features of myocardial infarction in the ECG. When we do a heart echo, we see that there are features of myocardial infarction. However, this heart looks very typical. It looks like a fishing tool. And this tool is such a Japanese tool. It is called a Tacotsubo. That is why it is called Tacotsubo. However, when we perform coronary angiography in this coronary angiography, there is no significant narrowing of the coronary arteries. And more often than not, there is indeed this preceding stress, which is precisely something that has affected the person very much over a period of weeks, months. Most often, this condition calms down and it all returns to normal. Of course, we perform further examinations to possibly also distinguish whether we are dealing with other disease entities, because we also have, of course, infarctions in women, the so-called mino K, that is, for example, without narrowing of the coronary arteries.

Agnieszka Graczyk Szuster
Also a woman's heart, a woman's circulatory system is really different and we have different stages in life where we need to pay attention.

Monika Rachtan
I think of the heart-brain connection, because it seems to be very important. We women experience certain situations more, we often take more to heart something that happens and it can be a trivial thing for someone. Like you said the death of a cat. On the other hand, it can be a very serious problem that we find difficult to deal with. It is often the case in your practice that a woman comes to you. You see the beginnings of an illness that is your lot, one related to the heart. But on the other hand you say Gee, I'm not going to go any further, If this patient doesn't go to therapy, doesn't go to a psychologist, to a psychiatrist, because I, as a doctor, as a medical professional, can see that she has, for example, symptoms of depression and that you know that if there is no spark between you and this psychiatrist, then you can just treat and treat.

Agnieszka Graczyk Szuster
Absolutely. Listen. The situation from the day before yesterday. I even wrote about it on LinkedIn yesterday because I was so moved by this girl, a 24-year-old girl called Anna. A girl who came to me because of complaints of chest pain. But as she started to describe, because I never ask the patient only about the complaints, but I also ask of course about how she lives, what she does, what she works, Because this, so to speak, in the interview is the most important thing. On the basis of the history, I am able to tell whether the patient has a cardiac complaint or not. And this girl, first of all, absolutely qualifies for psychological counselling, because 140 140 kg in weight, that's a BMI of 50 almost, because she's also quite a low person, who already has various such endocrine disorders, takes care of her parents who are ill, that is, she has premature heart disease in the family. Father, stroke, mother heart attack and basically and the cat is still there and she, and the end, and she has no life other than work. Standing work for 8 hours, parents plus this pet and she and she basically busies herself all the time because she can't manage it all, looking after her parents, working her weight.

Agnieszka Graczyk Szuster
So the first thing we did, of course, was to develop bariatric treatment, whereas absolutely the first thing she needs is a psychologist, a psychologist, a psychiatrist perhaps, because she can't handle it otherwise, she can't handle it.

Monika Rachtan
How do such patients react? Because you know, because it's still the case today that when you hear from someone Listen, maybe it would be worth consulting a psychologist, a psychiatrist? It's people saying are you making me crazy? I'm not a crazy person. Why should I go to a psychiatrist? Why should I go to a psychologist? And I don't know how it is. I sometimes tell people that, you know, listen, I can see that you have a problem. Maybe go out with someone, talk to a specialist, a psychiatrist or a psychologist. Or maybe go to a psychologist first and then he can tell you what to do next? Well, because, you know, I'm not a medical person, an expert, to advise you so much, but that's the way I look at you and I'm worried about you. And, on the other hand, what is it like just when the doctor says it, when it comes out of the doctor's mouth? Does it happen to you that you say Mrs Teresa, maybe it would be worth talking to a specialist, to a psychologist, to a psychiatrist? And Mrs Teresa stands up and says You are a hopeless doctor, you can't treat at all.

Monika Rachtan
You are unqualified and you are making me crazy.

Agnieszka Graczyk Szuster
This has never happened. Absolutely not happened in my practice. Usually these people actually open their eyes and listen and really talk, because they come very often. I don't keep statistics about my practice, In terms of how often my patients come in with psychosomatic disorders, but the ones who come the first time, then of course they don't come again, because I say they don't require a cardiologist, they just require other specialists, I think 20 30% have that psychosomatic. And once we get past that it's the ECG, the echo is fine. The blood pressure, the risk factors, that it's OK, the lab parameters are also ok, and then I come in. I prepare this patient first that the cardiologist really doesn't and that he doesn't have to look somatically for any, because these are not somatic complaints. They arise from the head that it is, however, a problem of some kind of anxiety, depression. Is it really work overload. And it's usually the case that later on, after some time, these patients, even some of them come in and say that it's ok, for example, they take this medicine, they take that medicine, it's great, there's no palpitations, there's no tightness in the chest, that it's all actually very many people have manifestations of actually these anxiety disorders, depressive disorders in the form of palpitations, stabbing pains in the chest.

Agnieszka Graczyk Szuster
But of course it has to be ruled out, these cardiac causes. And so I have to say that over the years it seems to me that people are getting softer and softer about it. That is to say, there's no arguing that I'm not, that I'm making someone look stupid, although that's such a very disrespectful term. Well, but there's a lot of overload, tension in our work, in our personal lives, so I think these are people who read, hear that a colleague has already been and so on, so they benefit from that kind of care, because it seems.

Monika Rachtan
To me, the most important thing in all of this is to allow that inner voice in your head to be heard when you're sitting alone or standing in the shower. And to say to yourself gee, I've got a problem, I've got a problem. And this problem is not a somatic problem, it's just, well, let's not be ashamed of what's here, what's not allowing my body to function normally. I think that the fact that doctors now have the courage to dig into their patients, not just tap them with an earphone, put a machine to work, but that they have the time and inclination to delve into the patient's situation, because the patient is not an island. There is a whole environment around that patient that affects them and we have to realise that this environment can give us good emotions that make us happy. Yes, it can give us negative emotions that influence us to feel very bad, but we don't feel bad that we are just sad. It's just that our heart hurts, for example.

Monika Rachtan
And I think it drives itself too. Because if someone has these discomforts just related to some kind of palpitations, prickling, it drives that emotional state of theirs even more into something like this, which makes them worry about their health. And this anxiety is even greater and these symptoms are further exacerbated.

Agnieszka Graczyk Szuster
Definitely yes. As I say, I have a lot of people who, for example, work in corporations and banks, who come from this type of background, and they are young people in their 20s, 30s and 40s who do not have any cardiovascular risk factors, that is, they do not smoke, they are still fairly active, although this also varies, but, above all, they work a lot and are overloaded with work. As far as women are concerned, let's say this is the order of the day, because, despite everything, there is no equality in families and in the home, and women often take on a lot more. They have very responsible jobs, they have children and we are still the sandwich generation, often with parents to look after and a husband who is not necessarily always 50/50. Very often, however, women still shoulder a lot more, and this resonates in our conversations. And then there's the unravelling of the fact that you have to pay a little attention to yourself, that there has to be time for a massage, for a walk, for a night's sleep, because this is the source of all the complaints that my female patients come to me with.

Agnieszka Graczyk Szuster
Hardly ever happens Girls for example. I had these two girls who worked in a bank. When they changed jobs they came to me. One came a year later, the other came six months later. They say zero complaints, they changed jobs, complaints completely. Such tension, such stress. Of course, I'm not saying this is the case in all banks, but they just happened to work in such a place. Perhaps they just didn't fit in. They probably didn't check their own, perhaps not so much their predispositions as their expectations. Perhaps to where they want to work and where they want to be anchored for the long term.

Monika Rachtan
Me thinks that this whole situation of 40 50 year old women is causing them to give up sex too. And does sex that is also regular, that we are satisfied with, also translate into our heart health?

Agnieszka Graczyk Szuster
Of course it is. First of all, stress is physical exertion, right? So the more of that physical exertion, if we're talking about physical exertion at all, I'm not talking about just sex of course, but in cardiology 150 300 per minute. 150 to 300 minutes a week. That's kind of the standard. This is moderate exercise. That is, it's such a leisurely bike ride, walking at such a faster pace or a swimming pool, and it's really up to these 300 minutes that is the optimum amount of exercise. Sex is absolutely desirable. After all, sex releases a lot of endorphins and it is necessary. It relieves tension, lowers blood pressure, lowers the heart rate. So if it is possible, let's absolutely not give it up. Of course, peri-menopausal girls may have different, different dysfunctions. They may have different feelings of discomfort, because we also have these changes that are in the vagina. We have a certain dryness of the vagina, a decrease in hormones, we have less desire for sex, but I think absolutely don't give it up, because it's something that makes us much younger, much more relaxed.

Agnieszka Graczyk Szuster
I talk to my patients many times about sex. I think it's more often a problem for men, though, because women very often really withdraw after 40. On the other hand, men 70+ and 60+ are also active and we talk about this too. They ask, for example, whether they can use certain preparations while on certain medications. I have to say that there is indeed a difference between men here too. For men it is more important, for us it stops being important. But I think that comes from the fact that there are just children, there are parents to look after, work, you have to do the shopping, laundry and so on, so that's probably it too. But sex is something that is very desirable, also in terms of reducing the risk of, for example, developing high blood pressure.

Monika Rachtan
You mentioned children and I once heard such wise words that seem wise to me because they are not for everyone. Marcin Prokop, who said that if children are the meaning of your life, then your life has no meaning. And I think to myself about those 40-something girls, because I think husbands are like a child coming out of the house. Of course they feel different emotions, but generally now we'll live it up, we'll go on holiday with Grazyna, we won't have to worry about the kids, they'll be at university, we'll finally have a life. And Grazyna, unfortunately, sits there and says Well, what am I going to do now? I won't be needed by anyone. And that's what you said, that Grazyna doesn't want to love anymore. Grazyna doesn't want to go out anymore. She doesn't feel like going on holiday anymore, that it's all changing so much for her and somewhere in there her life is becoming so flat. Whereas he is, he's experiencing a second youth. But you know, I know girls who, at the age of 45, say when their children leave for college in October, they put on red underwear and say, now we'll live.

Monika Rachtan
And I think these words of Marcin Prokop that I quoted just illustrate this situation, that if we have young children, we still have, like I have 30-something years, and we do something for ourselves. We don't just look after these children, we work, we love our husband, we cook dinner and all that. Obviously what the girls are doing, but also just having those five minutes to ourselves, then it's easier for us to get through that stage we're talking about. And I think it's worth it for all of us. Whether we're in our 20s, whether we're in our 30s, whether we're in our 38s or whether we're in our 47s, think about ourselves and also find those five minutes for ourselves during the day. And even if, in those 5 minutes, you listen to a programme on patient first to be healthier, that's well used too. 5 minutes for yourself, right?

Agnieszka Graczyk Szuster
Of course it is. And going back to what you said, going here to Warsaw, I was talking to a friend who is in this situation right now. She's my age, but she had these children much earlier and both her daughters went to study in Warsaw. And now I'm asking, well, how do you feel? There is the empty nest syndrome. She says no. I have so many different activities. Here zumba, here horses, here meetings. She runs an agency. She says she doesn't feel it yet, that she just has her own thing. She's also been involved in various other things all her life, so there's more to it than that. I, on the other hand, had my children quite late, because I was 35. I have two sons, so they are teenagers now. Yes, they're entering such a difficult time. That's cool too. And that's how I started thinking about it, that it's going to happen to me one day too. And for now, though, this life is very much about the children. But then I thought, actually, the whole period of a woman's life is divided into several such stages And it's having children, or motherhood, that's really 20 years, right?

Agnieszka Graczyk Szuster
So I think to myself so good, up until 35 I lived without kids, so it was great and I was able to organise so much of that time, I was doing all sorts of things. Then 20 years there are kids and then there won't be kids again. They will go their own way. So I think those children are just somewhere in there and that needs to be taken care of somehow, to understand that they're not forever, they're not ours. So I think that this time before and after will not be particularly different. Maybe there will be different activities, because I will be older by then than what I was doing before having children.

Monika Rachtan
So are you planning to crochet?

Agnieszka Graczyk Szuster
No, no, no. Maybe I'll go to Kilimanjaro again? I don't know.

Monika Rachtan
We've had a fun conversation. Because it's not just a conversation about medicine and health issues. But let's go back to doctoring a little bit. And now the question is what should we women pay attention to when we are in our 40s? What parameters? Maybe what tests to do to know that our heart is ok? Or to know that something is starting to happen and it's worth introducing some intervention.

Agnieszka Graczyk Szuster
First of all, I would recommend to all the girls who are watching us and are over 40 to do the 40+ prevention. There are these 40+ tests. They are free of charge. They're paid for by the National Health Fund and there are actually, at least basic parameters like morphology, so you can find if someone has anaemia. That can also give you chest pains. There is a lipid profile, which means we know if we have a lot of that bad cholesterol or if we are at risk of atherosclerosis. Then there is a glucose measurement and, of course, there are kidney parameters, liver parameters, a few more, there is a blood pressure measurement, a weight measurement and a body mass index calculation. Very often we do not know that we are already obese, which is a disease, and 25% of Poles are already obese. Unfortunately, and there is more and more of this, because we are eating more and more and growing. So first of all, 40+ preventive examinations. On the other hand, people who still only add.

Monika Rachtan
As far as this programme Profilaktyka 40+ is concerned, that on the Ministry of Health's website there is a list of institutions that are implementing this programme Profilaktyka 40+. And I remember, I think three years ago, the Ministry of Health two, three years ago introduced this programme, because it was somehow after the pandemic, that everybody said that Poles didn't get tested in the pandemic, so let's do the Prevention 40+ programme. And then it was said that this programme would be with us for about six months, and it's already been in the system for a very long time. But unfortunately, your response to this programme has been negligible, and we very much encourage you to have these screenings because they are free. And it's also nice that we go back to that doctor afterwards, because it's often the case that someone does some tests, picks up the result, throws it in their bag, even if they're doing it privately, looks at some arrows there, and well, pretty much everything's ok, and doesn't go back to the doctor. And here, if we go back to the doctor just within the framework of the National Health Fund, well then we have the certainty that simply someone has looked at these tests, at these results, looked at them with a professional eye.

Monika Rachtan
But what other tests are worth doing?

Agnieszka Graczyk Szuster
I mean very important even before we start investigating anything, because 40+ here we kind of have sorry, 40+ is one of the programmes that is for certain groups, that is over 40. But if, for example, we have a loaded family history, which means every woman, by the way, men, should also know their family medical history, this is very important. This is one of the first questions I ask during a medical visit. That is, for example, if our mother or our sister has had a heart attack, stroke, bypasses, stents of any kind put in place before the age of 60, this is a risk factor for us. Even when we are 30 35, we already need to know about it. Because the question is why did she become so prematurely ill? Similarly, if the father got ill prematurely, that is, before 55, the father or brother had a heart attack, stroke, atherosclerosis of the arteries of the lower limbs, that is, atherosclerosis in any place, in any vascular bed, this is a risk factor for us, that is, a premature onset of cardiovascular disease in the family even for a 30 35 year old is already an important signal that these examinations need to be done earlier, because very often the cause of this premature heart attack, for example, is a disease of the lower limbs.

Agnieszka Graczyk Szuster
There is, for example, familial hypercholesterolaemia in a dad who died at 40 or earlier. And it's very easy to find it in these 40+ studies. Also, as if preventive screening is one thing, but it is very important that we know what we have in the family, what are the oncological diseases? That is of course its own way too, you should know and you shouldn't miss it. And if we are, for example, an obese person, like Anna mentioned here before, who 24 years old came to me, she doesn't have hypertension yet at the moment, but obesity is the tip of the iceberg. Underneath the taffy is hypertension, diabetes, hypercholesterolaemia and further complications. So she as not going to reduce that weight. So here I am also talking to other people who are overweight or obese, she is going to develop further diseases before long. So these are people who are even 25, 30, 35 years old. They should already be doing this kind of basic screening package as well. Of course, weight reduction is key here, but this is again the support of a psychologist, right? Because this is most often also some kind of problem, not only hormonal, but very often excess calories as well.

Agnieszka Graczyk Szuster
And again now what is most important is lifestyle, because research itself, family history itself, but in fact everything that is in our hands, It is absolutely verifiable, changeable, even if we already have some disease, or even if we already have hypertension, hyper cholesterolaemia or other diseases that lead to these premature deaths. We are able to control all of that. We can stabilise blood pressure, stabilise cholesterol. And here is a huge request. Let's take cholesterol medications. They really do have excellent studies. These are the first-line drugs in cardiology that reduce the risk of death, extend the life of patients. And we have terribly here such anti-statin movements on the internet. And a lot of our patients come to our cardiology practice and say they're not going to take this. And this is where treatment beyond lifestyle is also key. That is, we know that diet, we know that physical activity that I mentioned, those 300 minutes a week, well, but also to know that our risk factors that come from our lifestyle, because we don't move, for example, and we have a bad diet, then that's manageable too.

Agnieszka Graczyk Szuster
Also, hypertension, diabetes, hyper cholesterolemia, nicotinism, all of these things then influence the fact that we become ill sooner. There was a study in a group of men who suffered a heart attack before the age of 40, and I'm quoting the men now, because it's an earlier onset in them than it is in us women. And 90% of these men smoked cigarettes. How strong a risk factor is that? 30% of the male population in Poland smokes twenty-something per cent of women smoke. So if we focus on lifestyle, on preventive screening and on what we need to know about our parents, our siblings, then when we have those points taken care of, so to speak, I think we can really feel strongly about safety.

Monika Rachtan
In Poland it is often said that there is a shortage of doctors, that there should be more doctors, that there is a shortage of specialists. You have this feeling that if Poles stopped smoking cigarettes and had a normal body weight, half of the doctors could look for another job.

Agnieszka Graczyk Szuster
You know, I think in general. In Japan, for example, there are fewer doctors per 100,000 than in Poland, and they have a longer survival rate. There is, you know, there are these blue zones where a lot of people live over 100 years, and there the number of doctors per 100,000 is less than in Poland. So, unfortunately, I do not join the number of people who say that we do not have enough doctors in Poland. Of course, in some places there are too few. However, I would say that patients do not have to go to the doctor for everything. Our patients are often uneducated, as, for example, they come to the doctor during an exacerbation of various infectious diseases.

Agnieszka Graczyk Szuster
If everyone knew that you can take paracetamol, you can do nebulisations in case of some cough and only if there is no effect, only then do you go to the doctor with some severe fever and so on. Not everything needs to be reported to the doctor straight away, that many illnesses we can manage. Many we can simply deal with at home.

Monika Rachtan
Or take the advice of a pharmacist. Because also let's not forget that we have educated, really great professionals, who for 5.5 years I think work very hard during their studies and who are in the pharmacies waiting for you to just come and ask and get advice. And really the pharmacist in my opinion is not. It's not scientifically proven, but in 50% cases he could replace the primary care doctor or the paediatrician, because he has this knowledge. And it's not some secret knowledge that you don't have, that you have to have, that you have to get by graduating from medicine just concerning simple diseases like viral infection.

Agnieszka Graczyk Szuster
Viral infection, viral diseases are several days 3 4 days viral infections. They pass. You just have to go to bed, hydrate, take some medicines, the kind that are just antipyretics, painkillers and they eventually go away usually on their own. No essentials. There are no antibiotics here. Of course, in viral illnesses, we do not treat the flu, we do not treat with antibiotics, unless there are some complications, but indeed we certainly need cooperation. If I may, if I may, excuse me, refer once again to this number of doctors, I, for one, think that the function of a physician assistant in Poland would be very useful. And it could, of course, be a person who is educated in this direction. I think these studies will probably come into being soon, or professional studies, because I might not do many things during a visit, because these are simple things that can be done by a person who has medical training, knows the drugs and the names, but could also be such a first pillar who decides whether this patient requires, for example, simple treatment of hypertension.

Agnieszka Graczyk Szuster
There are almost 11 million Poles in Poland who have hypertension. If I could serve in this way, sorry for the ugly word, I should not have to say it. I would be able to monitor many more patients in this way. If I had a physician assistant who says Mr Smith has 130 x 50, this one has this average, the next patient has this average and we basically tick off ok, this one is stabilised, this one is stabilised. First of all, the patient comes to me. The treatment of hypertension is a rather straightforward matter and that is always in my opinion or in most cases manageable. But this could go through a physician assistant, and I could already be dealing with patients who have, for example, severe exacerbations of heart failure or patients with such circulatory, coronary patients. Of course, I would also see pharmacists in our group, but I don't think we have this work well organised. Hospital work, for example, is very often done by doctors. Unfortunately, residents are also often hired to perform such administrative secretarial functions, And these are people who, at this point in their residencies, should already be learning their profession, learning, gaining experience, standing at the operating table or with a senior doctor for an appointment.

Agnieszka Graczyk Szuster
And this exchange of knowledge. On the other hand, there is a lack of support staff, which could increase the productivity of doctors, because we are ready. I could easily work a lot more, because I sometimes have the impression that my work is administrative. I could give a lot more out of my head for patients, I just do the administrative things that I think a medically trained person could also do instead of me.

Monika Rachtan
When you look at what the work of a cardiologist looks like in Poland, as you have presented it to us, as a woman, an educated person, an entrepreneurial person Are you a little disappointed that this is the way doctors work in Poland? And if you had the choice, would you go into medicine again?

Agnieszka Graczyk Szuster
Yes, yes, because I love my profession and I feel very comfortable with patients. It's something I've always wanted to do. From the age of 12 I wanted to be a doctor and from the age of 12, basically from high school my whole life was geared towards me getting into medicine and not yet cardiology at that time. But first I wanted to be a paediatrician.

Monika Rachtan
But that's what I mean, this disappointment. Because, you know, we women set ourselves different things in life, different goals and we strive. Children's careers, a beautiful home, white curtains, what each of us wants in life. But then comes that moment of verification. I think when it comes to the medical profession, it's very much about those dreams. There were many young doctors sitting on the couch here. There was Sebastian Gancerz, who talked about young residents and burnout. We were supposed to talk about medical education, and it came out that we had a very depressing conversation about how residents are treated in hospitals. And you know, when you're in your forties and you look at what you thought when you were 19, going into medicine. And when you see what it's like today, as a woman, as a doctor you say well cool, I've got a job. But do you say a bit disappointed.

Agnieszka Graczyk Szuster
Of course I was disappointed, but I would still choose this profession again because it is something I want to do and have wanted to do all my life. Also, this is my place. Whereas of course I have been disappointed many times. I think that every person who goes into this profession also has a bit of an expectation of really learning and doing what they want to do. I, for example, haven't done many things that I would have liked to do. I still have in the back of my mind that there are still some things, some areas. I still have this urge to develop, to learn, I just have this predisposition to it. I think it's important to have someone at work who will support us, someone who is older and experienced. A master, a mentor, whatever we want to call such a person, but it's very important, because, unfortunately, there are a lot of people on the professional path who, well, unfortunately, are hostile to us, because they have their own different expectations, they also have different criteria, they want to do something different.

Agnieszka Graczyk Szuster
These are also different bosses who, as I said, have their own specific expectations of their team and not always a person will fit in. Not a given person, a given person may not have the aptitude for the job. So I think that kind of person who is such a bit of a patron of us and that's still unpopular in medicine, it's popular in business mentor, coach and so on. But I can see it breaking through as well. I, for example, used to receive such advice, I had several sessions with a person who, I can say, is my mentor. Anyway, I later resigned from the clinic after one such session. I worked for 12 years in a teaching hospital, which is the best centre in terms of cardiology in Poznań, in Greater Poland. But I found that I probably have a slightly different, different preference, that I'm a person who would like something more than this kind of somewhat restorative work, and I guess, well, probably what I'm doing now is more. It resonates more with me than what someone told me to do, right?

Agnieszka Graczyk Szuster
Also, this is more mine than what it was those three years ago. Also, such a person is needed and little, she is needed very early in my opinion. I would have gladly taken such a person in 10 years earlier.

Monika Rachtan
I asked about this disappointment. Maybe you were surprised, but that's purely because I hope we get our message across to normal, ordinary girls, the kind that have.

Agnieszka Graczyk Szuster
I am also normal, ordinary.

Monika Rachtan
What I wanted to say about that is that we often put the doctor in this position of maybe not God, but someone better than the rest of society. And I've been talking to women doctors more privately recently and it turns out that we all have the same problems. And it doesn't matter if someone is a doctor, a journalist or is a teacher. Every one of us at a certain age, at a certain stage of life faces the same problems. And that feeling of disappointment, that feeling that something didn't work out for us, that feeling that we could have done something better. It will always accompany us. And I don't think there's any point in getting too worked up about it and getting down and going back, just to improve the crown, as they say, and move on, Bo. Well, that's because even the doctor can sometimes say that he imagined it all differently.

Agnieszka Graczyk Szuster
I think a lot of people in our profession imagine at the beginning that it will be. I idealised the profession a lot, but it's really, first of all, a lot of hard work, an awful lot of learning, that goes without saying, and unfortunately you very often get slapped around that you're not allowed to do something. I really didn't achieve many things in my professional life because someone simply didn't allow me to. Because someone else was in front of me. And that disappointed me a lot because I was the person who wanted to but like I say I don't fold my arms and I don't recommend anyone here. I really think that you have to look sometimes, that you can do something different that is much more interesting, more ours. Someone for themselves, someone, any of us. Each of us definitely, definitely need to get those two sentences out there. Each of us has a place, it's just that sometimes you have to look for it. You have to go through five different places, taste, but you find that one place. I think I am in the right one.

Monika Rachtan
Dear girls, I think to myself that if you have listened to this talk, you have come to believe that, first of all, you should do preventive examinations. You should know something about the health of your loved ones, your mother, your grandmother, your aunt. It's also a nice opportunity to get together over coffee, just to talk. And it's absolutely not a quiz, it's just a simple conversation. Above all, we saw that Agnieszka Graczyk Szuster, a doctor, is also a woman who faces exactly the problems she faces at the age of 40, realises herself, and thanks to this she is healthy, because a healthy head makes a healthy heart. Thank you so much for this testimony that you have presented to our viewers, viewers today. Dear girls, I invite you to subscribe to my channel. There will be more of these conversations about women, about strong women, here in the new season, so I hope we will sit down for a coffee like this on Wednesday and talk about women's things. Thank you very much. This was the Patient First programme. My name is Monika Rachtan. Thank you. Agnieszka that you accepted the invitation.

Agnieszka Graczyk Szuster
Thank you kindly.