Polish Society for Holistic Medicine - a new direction in healthcare. Episode 106

Artur Mamcarz
You know, I liked you. Don't write to your patients like that because you advise me to change my wife and job. This is the realisation of a dream. Maybe that sounds very strong to start this conversation. Death is a necessity and destiny for all, and old age a privilege for some. Pulling a patient who has been in daily life into a hospital bed is stressful a lot and involves negative emotions. So if the patient can be at home as early as possible, it is better that way.

Monika Rachtan
Professor, why is such a company being set up?

Artur Mamcarz
What is a patient who often has chronic kidney disease, type two diabetes, is post acute coronary syndrome, has heart failure and pain syndrome?

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme. First of all, the patient. You have probably heard many times that we should approach health, that we should approach medicine holistically. But what does that actually mean? This is what I am going to talk about with my guest today, and that is Professor Artur Mamcarz. Welcome, Professor.

Artur Mamcarz
Good morning.

Monika Rachtan
You are a cardiologist, an internist, but above all, what we are going to talk about today is the founder of the Polish Society of Holistic Medicine. Professor, why do you set up such a society?

Artur Mamcarz
This is the realisation of a dream. Yes, it sounds very strong to start this conversation. But indeed I have been involved in these pillars of academic medicine for many years, namely science, didactics and treatment. These are the three main pillars and didactics, both graduate and postgraduate, are very close to my heart and I feel, and hope, that I do it with a passion that makes these things not only enjoyable for me, but also for the people who are involved in such processes. But in fact it was a dream that stemmed from the fact that for some time now we have been talking about such a gluing together of medicine or stitching together one could say, because a little out of necessity some time ago it was split into narrow branches very much. The narrow disciplines of cardiology, haematology, diabetology, nephrology were separated from internal medicine.

Monika Rachtan
Do you want to tell our audience that there used to be one internal medicine doctor who treated all conditions?

Artur Mamcarz
Yes, it used to be like that, and it still is. A certain proper role was taken up by the family doctor, because this system based on family doctors shows that it is the very essence of this gluing together of medicine. Because the patient crosses the door of the family doctor's office, who brings together different disciplines, who is at the frontline, who has to recognise certain processes, sometimes also using consultations. This is the kind of understanding of holistic medicine, that is, the patient who walks through the doors of the practice goes to the hospital ward, to the clinic. This is a patient who has some symptoms, and he probably doesn't understand that he's going to be dealt with by a doctor who only deals with chronic kidney disease or a certain valve defect, or a type of proliferation that's related to haematology or type two diabetes. Only that is a patient who has chronic kidney disease, type two diabetes, is post acute coronary syndrome, has heart failure and a pain syndrome resulting from the fact that they have, for example, a key medical problem of the modern world, which is obesity, and they have pain syndromes that affect different areas and they will take medication. And sort of the essence of this understanding, this holistic treatment of the patient, is to approach all these areas together. Someone has to do that, using, of course, the consultation of specialists when that consultation is needed. It's also mental. It's also emotions. It is also relationships. It's also problems that come up. You have probably talked more than once about cardio diabetology, cardio psychiatry, cardio sexology in the company that we are setting up, because this is a process that started at the beginning of 2025. There are specialists in oncology, family medicine, sexology. Neurology. Cardiology. Of course. Hypertensiology, endocrinology, psychiatry, because psychiatry is also a very important area of our joint work. Anyway, if I represent cardiology, I want to say that for the first time next year there will be guidelines like this, which can be called cardio psychiatry, or mental health, cardiology.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan I invite you to join us because this is also very much related. We know that many cardiovascular diseases are a consequence of obesity, and obesity is often not just a problem of the body itself, but often a problem of the head. So it would seem logical that, when a patient presents to a cardiologist with a myocardial infarction and we see that the patient is obese, that we should also reach out for that psychiatric help, and consider whether it is needed, and whether there is any time for it at all during such a visit or in hospital, when the patient arrives precisely because of a myocardial infarction, for example?

Artur Mamcarz
This is a challenge, because at the time I started my medical journey, medical adventure, career we can call it variously, this journey, that is the beginning of my professional work.

Monika Rachtan
He has a huge passion too.

Artur Mamcarz
He's a patient, he was lying down after a heart attack for 2.5 3 weeks and there was time to talk to him about things. Anyway, some anecdotes I still remember to this day about my first relationships and the language I used. That has changed over time, but I will allude to the fact that today he doesn't lie down for 3 weeks, he lies down for 3 days. Sometimes he goes to one doctor on Friday, to the haemodynamics lab, who does a closed vessel patch for him, widens it, puts the equipment on. On Saturday there is an on-call doctor who talks to him, but also takes care of other patients. On Sunday another one, and on Monday another doctor discharges him home. Therefore, it is as if this continuity of care, if only in hospital, is very short. And this procedure is more efficient today. Of course, we want the patient to be in bed for a short period of time, because taking a patient who has been in daily life out of a hospital bed is very stressful and involves negative emotions. So if the patient can be at home as early as possible, it is better to do so. On the other hand, the reason I say this is because we do not have much time to raise important issues. Hence the very big role of GPs. It is to them that we direct this offer of, let's call it, education. I meet with them very often, I have great pleasure in such discussions. We carry out educational projects that bring together family doctors and specialists. They present us with some of their problems or examples of patients, and we discuss with them how best to treat them. Therefore, it is as if there is no time, if you answer the question directly, for these emotions. Hence it is the GP, the cardiologist, the diabetologist, the nephrologist who has to take over a little bit of the communication skills. And I very often talk to psychiatrists who use language in their daily work. That is the main tool. Of course they have pharmacotherapy, very modern, but they have to inform the patient about it, who teach us how to build relationships. Maybe he will also refer to language, because it was a great intellectual pleasure. Working with Professor Bralczyk, with whom we prepared a book called 'Healthy Language' about how to construct a conversation, how to build a relationship with a patient, how many traps lurk, whether to build this conversation based on jargon, incomprehensible language, or on language that is understandable to the patient and involve them in the process so that they understand their illness more and learn it, because then they will be a very good partner.

Monika Rachtan
It's a bit like in our programme, because we also try to talk in a simple way about this medicine, which is very incomprehensible for the society, because it's not only for the patients, it is, it uses difficult terms, and we just want to explain, We want to come out with a simple message, so that this. taking care of health on a daily basis is not some difficult procedure, but it's an ordinary everyday life that everyone can introduce. But I wonder about one thing. Because when we have scientific societies in medicine, they bring together experts who very often hold important positions, meet at many conferences, discuss with each other. But I wonder to what extent such a discussion, to what extent such an exchange of experience affects those doctors who are really in this OPD, who do not live in a large agglomeration, who do not come to Warsaw for conferences, but live in a small town and receive their patients there. What are your observations? Do they also get this message? Because to me it is about our viewer, who is not always a patient in a big city, in a big POZ, where the doctor is so receptive to knowledge. Just sometimes he goes to that doctor who is not necessarily interested in a holistic approach to the patient.

Artur Mamcarz
My experience is that there are very many doctors who are interested. This is evidenced by the full rooms at the big conferences for GPs, for cardiologists, for diabetologists. These really are meetings where the halls are full. People attend, they discuss, they present their problems. What we have today is that, somewhat paradoxically, what the pandemic has done is that we have been given new educational tools in the form of online transmission, webinars that are going on. Then, when doctors of different specialities are in different places in their cities smaller or larger, and the doctors listening to us can turn on their computer and listen, ask. Sometimes it is also emboldening, because they ask a little anonymously, they do not personalise their question, sometimes with an important problem, so paradoxically this tool stays with us. We participate in such meetings often. But for me, of course, personal meetings are more important, because they allow us to establish a close relationship. They allow us to draw energy from each other, to learn from each other much more easily. For me, such educational meetings are precisely in the context of this holistic medicine, because we are planning various conferences, events and meetings that will touch on these areas of combining disciplines. We already have it very much designed, when we are just going to talk with a psychiatrist about communication, about emotions, about the fact that a patient, you said that a patient after a myocardial infarction comes out of hospital, which affected him during a certain activity, which he was not aware of, aware of his risk factors, He didn't really measure his blood pressure, he didn't have time to do that, he didn't know his cholesterol levels. Suddenly he finds out that he is sick and that's why he got sick, that he didn't take care of himself. But he has emotions inside him that are bad because it has taken him out of his work life, his family life. He had plans, some holiday, a task defined at work and suddenly he has a worse mood and sometimes he has a depressive syndrome. If we don't recognise this syndrome. That's why we are learning to do this. This thing that we call today therapeutic adherence or patient persistence in therapy we will put at this stage.

Monika Rachtan
That is, the patient will not be fit.

Artur Mamcarz
He won't take medication, because for him the main suffering is not a question of imagining that after a heart attack he has to take medication to reduce the risk of another incident, but he will suffer from the fact that he has emotions inside him. And if we don't extinguish the psychotherapy with this conversation or with modern medicines that will improve quickly. That is, building this relationship, this triangle. Sometimes I call it this way patient doctor, pharmacist. Because pharmacists have a very important role, especially in those centres you mentioned. In the smaller ones, where the patient always goes to the same pharmacy.

Monika Rachtan
And they are at the front.

Artur Mamcarz
They are the frontline, they talk, they see things, they look at how patients are treated. I respect this collaboration very much. We do different projects dedicated to doctors and pharmacists together. Pharmaceutical care can change the landscape of the effectiveness of the therapy, but the therapeutic team can include a physiotherapist, a dietician, a psychologist and doctors of different specialities. That's the understanding of this holistic medicine, and that's what I'm all about, to stitch it together so beautifully, so that the subject of our action the patient benefits the most, because that's the patient we're doing it for. And how communication can sometimes be unreliable? That's what I said about that anecdote, but I remember that story. She always makes everyone who listens to her laugh a little bit. When I was at the beginning of my career, I was discharging a patient from hospital after a heart attack and I told him in the discharge card writing this please avoid stress. And the patient was 50 years old. At the time I thought he was completely grown up, because I was 20 some years younger myself says You know, I liked you. Don't write to your patients because you advise me to change my wife and my job, because these are two environments that generate stress. I am more urging you to write to try to find ways to deal with emotions and stress. That is better advice, yes?

Monika Rachtan
And is a system where, for example, there is a wait of several months to see a psychiatrist ready for holistic medicine? Is the patient. Is there a chance that a patient who is discharged from a cardiac ward after a heart attack, let's say within a week, will be taken to a general practitioner, where further recommendations will be worked out, that he or she will see a psychiatrist within, let's say, a month, because if he or she is seen in six months, all the effort made by cardiologists and general practitioners will have been wasted.

Artur Mamcarz
This is the very essence of GP care and education in these areas. After all, we don't deal with a psychiatrist in the course of our work in cardiology, diabetology or nephrology either. Of course, the ideal situation, such a dream, is for there to be other specialists on the teams or in multi-profile hospitals. Sometimes this is the case. And the patient will be consulted by a psychiatrist or a diabetologist or a nephrologist, a pain management specialist, because sometimes that will completely degrade him. That's how emotionally he will comply. But of course that's why we're talking about it, that a psychiatric consultation will probably have to happen or should happen in certain situations, but in a lot of sensible psychiatrists who are aware of these limitations, they teach other doctors that in their hands are tools that are safe, effective. We need to know more and more about not only antiplatelet treatment after acute coronary syndrome or treatment that reduces the risk of coronary artery occlusion, but also treatment of emotions, because sometimes this treatment is in our hands. We can, we have the right, the capacity to prescribe these drugs.

Monika Rachtan
That is, the primary care physician should.

Artur Mamcarz
And a cardiologist too.

Monika Rachtan
The cardiologist should also take a holistic approach to the patient. Just whether he or she is in the environment...

Artur Mamcarz
Agreed?

Monika Rachtan
Consent, understanding and comprehension on the part of patients? Because quite frankly, Professor, this may still seem ridiculous to the specialists or some such contrived thing, but I can imagine an elderly woman who ends up in a cardiology ward, who has some sort of depressive episode, she doesn't admit it. She is aware that something is happening to her, but she doesn't go to a psychiatrist because she is ashamed. As it is in Poland, it is simply shameful to go to a psychiatrist. I'm not a crazy person. And now she goes to a cardiologist. The cardiologist on the ward says to her, dear lady, we have secured a cardiologist here, but I thought it might be worth it. And now, if there's this strong belief in this woman that I'm not a nut, I think she's going to walk out of that cardiologist's office, she's going to say I'm not a nut, she's not going to take antidepressants and she's not going to take those cardiology drugs either, because she's going to say this doctor is the nut.

Artur Mamcarz
This risk obviously exists. However, that is why we are talking about it and building this structure, so that such situations occur as rarely as possible. We have focused on this important area, very much about depression, anxiety and the anxiety syndromes that accompany the seriously ill patient. But I'm going to go into another area that holistic medicine will also associate with, because such a patient or a patient after a heart attack, with heart failure, with obstructive pulmonary disease, chronically ill with many serious diseases. Many elderly people have multimorbidity, they have three, four, five, six diseases. But I'm talking about vaccinations. I feel like I'm always using this phrase, that this is a pillar of medicine, of lifestyle. Like this whole conversation about holistic medicine. I am an orthodox advocate of vaccination. I talk about it at every opportunity and such a patient should also get the message, or a patient should get the message, that they should get vaccinated because the risk from a bacterial or viral infection, whether in season or out of season, is a very high risk of severe disease, which is the underlying disease, and vaccination protects against that. Some people will go in or take the opinion of their relatives, neighbours, children. Unfortunately, there is a group of people opposed to it who will discourage it. This is holistic medicine and we need to talk about it or another occasion.

Monika Rachtan
This is very important, Professor, because I will recall I already talked about this situation even in a programme about an oncology patient who was being treated for prostate cancer and went to. He was undergoing systemic treatment and he went to his primary care doctor asking if he could get a flu vaccination. And he was told that the doctor did not know whether an oncology patient undergoing systemic treatment could get a flu vaccination.

Artur Mamcarz
I immediately say maybe.

Monika Rachtan
Yes, he can. After which the patient did not know what to do. And because he was being treated many kilometres away from where he lived, he did not have the opportunity to have a heated discussion with his oncologist about this vaccination. He returned home. So the thoughts came and maybe it's not safe for him to be vaccinated after all? Or maybe I wouldn't do it after all? And it wasn't until he spoke to his oncologist that he was able to accept the vaccination. He even accepted it at the pharmacy, as far as I could tell.

Artur Mamcarz
This is another advance and another reason to talk about treatment teams.

Monika Rachtan
Exactly, but here again, there is a lack of information, of education. And I am not saying that the oncology patient should know whether he can be vaccinated or not, but that this knowledge here in primary care doctors and this desire to be holistic is not always, not even about the desire. To me it seems to be a certainty. Confidence in themselves and in their behaviour, that when we have an oncology patient, there's already this light that oh dear, then maybe I'd better not do anything, let the oncologist decide.

Artur Mamcarz
This is another challenge for such an association when we talk about this holistic medicine, that is, a holistic view of the patient and his or her various problems. And of course, such situations say. Are you too ill to be vaccinated? I hope they happen exceptionally. That education you talked about, I am talking about that too. It has to be carried out all the time. It is continuous education. We have a statutory obligation for continuing education in the health professions and I think we carry it out with passion, with pleasure. It is a necessity that comes from progress. But as long as we follow well the progress in cardiology, the cardiologist in diabetology, the diabetologist in nephrology, oncology and so on. As much as this holistic treatment of the patient is a bit of a challenge, because we have to speak to everyone about it. I often take part, as I am coming back to vaccinations, in meetings of many such specialist groups which look for solutions and tools to change the epidemiological situation in Poland, where there is a large distance to vaccinations and the vaccination rate is poor even in infectious seasons. COVID was an opportunity to do that. Right.

Monika Rachtan
Which we did not use.

Artur Mamcarz
We have not taken advantage. Again, this is a question of language. I remember a situation where a lot of people were talking about it and journalists and doctors. Simplifying the language, that if you get vaccinated, you won't get sick. It was the wrong message, of course, because many patients got vaccinated and got sick. There was a feeling that they had done it unnecessarily. Meanwhile, it has to be said that vaccination reduces the risk of getting sick, which means fewer people get sick. On the other hand, if you do get ill, if you are seriously ill, there is less risk of the disease becoming severe. That is to say, the chance and risk of heart failure complications of a cancer patient having a stroke will be different again. His primary disease then when he will have an infection. For many patients with chronic diseases an infection. Is risky as to the course of the disease and the bad course of such. Definitely hospitalisation. That is, having to hospitalise a patient with severe heart failure, chronic lung disease, with complications of diabetes, is risky. It saves lives, but the risk of hospital infection is higher.

Monika Rachtan
There is simply an increased risk of death in such patients.

Artur Mamcarz
It simply has to be said outright.

Monika Rachtan
It needs to be said directly, because we absolutely do not associate a flu-type infection with death. It is absolutely not in our minds at all.

Artur Mamcarz
But some patients die because of this.

Monika Rachtan
And is there still a point today in vaccinating cardiac patients against COVID 19? Are such recommendations coming out of doctors' offices?

Artur Mamcarz
There are recommendations, we talk more about covida. There are vaccination calendars for adults. They are published on the websites of the Polish Society of Family Medicine, the Polish Society of Vaccinology. We have also prepared in a multispecialist team, there is a document that has just been published, now others are being prepared, some of them are in print concerning the position of cardiologists with the participation of vaccinologists, i.e. doctors dealing with vaccinations against pneumococcal disease, for example, which say that vaccinating a chronically seriously ill patient against pneumococcal disease improves their prognosis. The same paper on covidium was produced concerning influenza. Now we will probably work more on vaccination against RSV, that virus which used to be associated with serious infections in children, and today we have vaccines. They have been available free of charge for some time for people in risk groups. Or for some primarily cardiac patients, but not exclusively. Or age is a risk factor. We also need to make it clear that above a certain age the risk of many diseases is greater and the availability of these vaccinations is greater. We need to publicise this. This is also an element, a pillar of medicine, of lifestyle, a pillar of holistic medicine. I think a lot of people share this opinion that if we did a ranking, rankings are cool and fashionable, yes? You can imagine the Decalogue. The successes of medicine. In the history of medicine in general, either the 20th century or the last hundred years, I'm of the opinion that vaccination is definitely on the podium. Many people think they are on the first place of the podium in terms of saving a lot of lives, reducing the risk of contracting a lot of diseases. Of course, there are other elements of public health, it is a question of certain procedures related to the protection of patients with infections, operated at least aseptically. It is also about taking care of the cleanliness of water, products. A lot of different things in public health, but such a strictly medical procedure is, I have the impression that, of course, some people say that antibiotics saved. This is true.

Monika Rachtan
But they also did a lot of damage.

Artur Mamcarz
But I think they have done more good. Of course, that has to be said. But from an epidemiological point of view, such a global point of view, I don't think there is a procedure that has done more good than vaccination.

Monika Rachtan
I asked a staff member at the Ministry of Health recently how, in the face of all that the professor has said, and in the face of all the information that medicine presents to us, how to encourage Smith, what to do? Because there is just such anger in me journalistically to push him through that door of his house. With my decision made, I go and get vaccinated. I am not asking about education now, because I think education is needed. You educate, I educate a lot of other people, I educate. People are not vaccinating. They don't vaccinate against flu, they don't vaccinate against pneumococcus. They won't vaccinate against RSV unless there are systemic solutions in place, which I don't mean to force vaccination, but which could have some impact.

Artur Mamcarz
Privileges for people who get vaccinated. I think this is a different conversation. The ladies that show the carrot and the stick have to be applied in certain proportions to the individual and to the groups that are subject to some kind of procedure. And of course a universal remedy probably won't be there, but I think it might be better to build some privileged situations for people who get vaccinated, for example, reduce the risk of getting the disease.

Monika Rachtan
What privileges might these be?

Artur Mamcarz
Health contributions of a different amount, yes? Smoking is also a risk factor for a great many diseases and is a disease that requires treatment. And of course there are different tools used, some more or less socially, ethically acceptable. In fact, we as doctors or I as a doctor will have to sort of recognise that a patient who smokes is the same patient as one who does not smoke, if they have cancer, they will need to be treated in the same way, it will be the same obvious offer for them. However, earlier, when we talk about this health prevention or primary prevention, when there is no disease, I think it would be possible to probably introduce systemic solutions that would give certain privileges to people who behaved in a health-promoting way, in the sense and education, accessibility and so on. So I'm not, I don't work systemically in health care. When I'm not looking for administrative and formal tools, yes? But I can imagine them. On the other hand, I think this is a solution. You are advocating more of a carrot and stick approach.

Monika Rachtan
Carrots?

Artur Mamcarz
Carrots.

Monika Rachtan
I think so, because the stick has already been there and as if in many situations it doesn't work. And even more so because we are in the face of disinformation, the internet, and I think the moment we would start punishing rather than rewarding, all those groups that are not conducive to a holistic approach to health today, that are on the internet and spreading disinformation even more, would activate.

Artur Mamcarz
I think this is some kind of solution, because of course we both know that there is a 'Lex Charlatan' bill under way, as it is called in the most general terms, that is, to find legal solutions which would, however, punish those who act to the detriment of public health on a large scale, it is not just doctors, because doctors unfortunately happen to be there as well. But these are marginal situations. But those who are not doctors, who appeal to the emotions of patients, often confused, often unprepared, who give an offer that is ineffective, that harms their health.

Monika Rachtan
But it is also often quick and pleasant. And that's the problem: medicine often gives solutions that require a commitment from patients. And on the internet, usually one magic pill is supposed to change our whole lives. And that is scary.

Artur Mamcarz
But if we have a situation where I don't want to use either the name of the people who are doing this, who are bringing together at their meetings these kind of let's call it large groups of people, promising them in return to use unproven medical solutions, an offer. And they say chemotherapy, I don't want to compare it because it won't pass muster, but then when these patients believe this message, they get really ill. Then they don't go to this man to see these people, they go to hospitals that are going to put in huge money, money from a system that has financial shortfalls. In advanced diseases, cardiology, oncology, diabetes, pulmonology treatment is more expensive. And we could prevent this if some of these patients did not follow these recommendations. So we need to find tools to discipline, to legalise, to punish those who act to their advantage. To the detriment of a particular patient and public health, they should be shown with such a black blindfold and should have lawyers, that is, systemic solutions at their disposal to eliminate such people from this space that causes harm.

Monika Rachtan
I know which meeting the professor was talking about and I have seen pictures of that meeting, a full room, where doctors who came there to defend the truth and medical facts were thrown out of the door by security guards. And I wonder why such people have the power to throw a doctor out of a conference? And why doesn't the system have the power to throw such people off the internet?

Artur Mamcarz
I am outraged by the situation here. I mean I think everyone who works and advocates for patients should have this opinion and there should be solutions to punish them.

Monika Rachtan
I am of the same opinion, for the reason that many times, when I publish episodes of my programme, it happens that such people write various untrue things in the comments.

Artur Mamcarz
We have to face it. We can do it.

Monika Rachtan
This is true. Professor, what will be the first tasks of the Society that is just being set up, the Society for Holistic Medicine? What goal do you give yourself for the first year of operation?

Artur Mamcarz
Including different medical areas, building such didactic structures. We are ahead of the first challenges that will be dedicated to GPs when we talk about cardio psychiatry, cardio sexology, because we also have a sexologist among the founding members of this cardio pulmonology society. When the symptoms are similar and the risk factors. Later we will try cardio oncology. We will be discussing pain syndromes just in a wide group, because they will involve doctors and patients who are dealt with by doctors of different specialities. So we are building didactic structures, We are thinking of a large exchange of such education throughout different regions, not just globally, in big cities, but we will try to direct the message to doctors in different centres, including those you mentioned. Smaller. Where, this access to information can sometimes be a little worse.

Monika Rachtan
And have you prepared any educational offer for patients?

Artur Mamcarz
I think, for the time being, we have not yet prepared. That is, of course, also a task. I think there are so many different areas where the right information to patients will result in their success. And, of course, ours too, because every doctor is in this profession because, for him or her, the success of the patient is a personal success and it brings joy and pleasure. Therefore, such an offer will also be dedicated. Today, I talked about a book we are preparing with a colleague who deals with one of the sophisticated parts of cardiology, namely electrophysiology, that electrical activity of the heart, but we are preparing it. He will be the author of one of the chapters. We are going to prepare such a book, which is called 'Travel Cardiology', that we are going to talk about how a patient with various cardiac problems must or can or should prepare to travel, often to distant corners of travel, is a beautiful part of our lives and we do not deprive seriously ill patients of such opportunities. On the other hand, we will be talking about how much time must pass after an incident, the process of therapy, how to secure oneself with medication, what medications to take with them. For the time being, this will be a book aimed at doctors, but the other leg of this will be directed guides. That's what I was talking about today, to direct guides, can you, how to live with the truth? And of course we can imagine. There are quite a few such guidebooks, of course, on the market aimed at patients with diabetes, for example, or with heart failure, but there are never too few, too many sorry, never too many such books.

Monika Rachtan
And I also thought, Professor, that maybe this path of reaching patients should be modified a little bit, because when I think of a guidebook, I see a guidebook that is somewhere in the clinic, so classically lying on a table. Whereas today the internet and social media have great power and maybe you could.

Artur Mamcarz
Yes, yes an app that can be sent out to patients and they can see for themselves. It's interesting because we have an app on our watch or on our phone. I click into the app and today we're talking about what should be the best thing to eat for breakfast. When I have problems with lipid disorders and I get, for example, the information This is obviously a tool that we will use for obesity. We are already thinking in this context and targeting doctors and patients. The process has begun of creating applications linked to simple tools to measure the patient, to weigh them, to measure their abdominal circumference and something should follow, so that the patient does it themselves and so that they know that it is very difficult what I am going to say now, such tests are being carried out. If a professional health worker, a nurse, a doctor, a physiotherapist, a registrar, a registrar measures the height, the weight of the patient and measures the abdominal circumference of the patient, that is different from asking the patient to take the same measurement. It is so that this difference was very significant.

Monika Rachtan
Very significant.

Artur Mamcarz
Very significant.

Monika Rachtan
Women know this best.

Artur Mamcarz
We have this feeling as patients. The experience of being a patient is common. Everyone is, is, has been or will be a patient. There is a temptation to cheat a little bit, isn't there? Anyway, we are preparing different activities. I also enjoy it in a didactic sense. I mentioned a book with Professor Bralczyk, it's now in print. When we talk. At the beginning of May there will be a book 'Sugar on the tongue', where Professor Bralczyk, Professor Czupryniak and I talk about diabetes, about the holistic treatment of the diabetic patient. Professor Bralczyk does not hide the fact that he himself is a patient and talks about it in his book. He talks about how he faces certain challenges. I am not giving away any medical secrets to this, because it is common knowledge. She talks about it in the many programmes and meetings she attends. But I'm also talking about it because a certain plan for some time from now, probably next year, is a book that will be about old age, because I kind of initiated such a conversation here and it was the professor who thought it was worth talking about. We have a super interlocutor, now geriatrics and diabetologist Dr Janina Kokoszka Paszko will be.

Monika Rachtan
I had the pleasure of meeting the doctor.

Artur Mamcarz
And the pretext for this was what Professor Bralczyk said. When we were talking at different threads about healthy language, about how to communicate with each other, what kind of language to use. Sometimes a joke is necessary, sometimes bold and daring, when the patient is waiting to defuse the situation. And Professor Bralczyk said "Death is a necessity and destiny for all, and old age a privilege for some".

Monika Rachtan
Well, yes.

Artur Mamcarz
It's nice.

Artur Mamcarz
Privilege says to some Therefore, let's do our best to live this old age in the most beautiful way. And we will do our best to talk about it too.

Monika Rachtan
I imagined when I asked about these tools one more thing. Maybe the professor will take up the gauntlet to create such a Facebook of health, that is, that all the rolls that go into the app, it could be, for example, within an online patient account. I go into the app and the rolls show me reliable medical knowledge, they are positioned for my conditions, for my needs. That is, if I am a patient with type two diabetes, the system knows that I am such a patient and it displays to me all the time. Mr Professor Czupryniak, who talks about the treatment of diabetes. It displays to me Mr Professor when he talks about cardiology and that this would be something great, something that does not yet exist at all. But take care of that reliability.

Artur Mamcarz
Super, super idea. It's Dr. Wierzbinski who will talk about psychiatry, Dr. Depko, about sexology. Everything will be credible.

Monika Rachtan
Well, that's exactly what I mean.

Artur Mamcarz
We contract such a project the Polish Society for Holistic Medicine and.

Monika Rachtan
Firstly the patient.

Artur Mamcarz
I think this is a great thing, because when we were talking about this misinformation and thinking about how to get these people off the internet, let's not get them off. Let's create our internet that is safe, that is reliable and where real medical knowledge is shown from experts and not from charlatans. Professor, well then I take up the gauntlet as well and we are agreed. Finally, I would like to ask what is so. You, Professor, have already done a lot in your life in the context of cardiology, internal medicine. What would you like to see happen in the Polish system to improve the lives of doctors and, above all, to improve the lives of patients?

Artur Mamcarz
This is a topic for a separate conversation, because there are many of these dreams. I think about many of them in this conversation. A lot of these dreams have found their verbal part, because it's like this is the kind of activity that will be the right communication that will result in a high quality of this message with building something. And this is probably the main dream of such a relationship between the doctor and the patient, which will result in us using all the possibilities to do, to improve the health of the patient, that is, to achieve these two goals, which in medicine are crucial in every discipline, which is to prolong the life of the patient in good quality. It's not just about prolonging the life of an incapacitated person, very much in need of care, care, involvement of other people who are sometimes not there, which systemically has to be solved. So it's a realisation through education, progression, conversation, building therapeutic adherence, the best relationship that will result in a longer life for the patient, in good health, in good quality.

Monika Rachtan
We are an ageing society and we should be aware that this life in retirement may be getting longer, but it is now that we should take care of our health so that we can continue to enjoy it in this good old age. Today, my guest was Professor Artur Mamcarz. Thank you very much for our conversation today. This was the programme First. Patient. My name is Monika Rachtan and I publish my programme on social media after all. Thank you very much.