Facilities similar but Czech doctors have way more paperwork, says Prof. Jan Marek of Great Ormond St. Hospital

Jan Marek, photo: Ian Willoughby

Professor Jan Marek is a lead consultant in paediatric and prenatal cardiology at London’s famous Great Ormond Street Children’s Hospital. One of the top specialists in his field in the world, Professor Marek worked for many years at Motol Hospital in Prague and retains close ties to the institution. I recently caught up with him at his office at Great Ormond St. – and before he was called away to conduct a heart operation – began by asking him how he had ended up at such a prestigious institution.

Jan Marek,  photo: Ian Willoughby
“Actually I was approached by colleagues. They knew me from international conferences.

“I was approached back in 2001 but they failed to appoint me because the Czech Republic was outside the EU. So it took another three or four years to get the work permit for me as a lead consultant.

“The post is quite high, so it requires expertise. I was probably just suited to working in the team. The team is very international. I’ve been here since 2005, so it’s more than 10 years now.”

Were there other Czech doctors here at Great Ormond St. before you?

“Historically there is the link with Czech paediatric cardiologists and cardiac surgeons through Mr. [Jaroslav] Stark.

“Mr. Stark was a very good surgeon, originally from Prague, who left the country after the Russian invasion back in 1968.

“He actually contributed to the establishment of the paediatric cardiac and cardiothoracic surgery at Great Ormond St.

“Although it was under communism, he also developed a programme that managed to get funding and invite surgeons and cardiologists from Motol Hospital. My recollection is that 15 people were trained under his leadership.”

You worked in the Czech Republic. You’ve worked here for over 10 years. Could you possibly compare the facilities at GOSH with facilities at an equivalent hospital, if there is one, in the Czech Republic?

“If we are talking about facilities for treating patients, there is no difference.

“All the equipment is the same. It’s international, so there is no difference.

“The difference is that there is much more opportunity for research and for teaching and education.

Great Ormond St. Hospital,  photo: Nigel Cox,  CC BY-SA 2.0
“If I compare it to Motol Hospital, the treatment of patients is very similar, or almost the same, I would say. The difference is mainly the research.

“There are some programmes that are very well developed in the UK, such as transplants in children born with congenital heart disease or cardiomyopathies. This programme is well-established here.

“Of course it also depends on the size of the area. The Czech Republic is a rather small country so in fact having a big transplant programme is unrealistic and there is no need for it.”

Is there greater opportunity for research here because there’s more funding?

“Yes, absolutely. And particularly here at GOSH. The resources are partly government and partly private – there are a lot of donations.

“A lot of research is being funded privately from multiple resources, from the UK or from overseas.”

Could you compare the treatment of patients here at GOSH and in the Czech Republic? I’ve personally often found in the Czech Republic that the standard of healthcare is good but the doctors and nurses can be quite brusque.

“Yes, I think that’s partly because the doctors are very busy with unnecessary work.

“I think doctors here in England have more time to spend with families, because they don’t have to do other work.

“Just for comparison, I think more than one third of employees at GOSH are administrators. In contrast, if I remember well the administrative staff at Motol was around 5 percent of all employees. So that’s one of the reasons.

“Another reason is that the doctors in Prague need to fill a lot of gaps. They need to move from one side to another side, while here we have allocated time.

“If I have allocated time for research, nobody can approach me, unless I am really needed in the theatre or there is some urgent case.”

So it’s really a question of workload, not of attitude to the patient?

Illustrative photo: Petr Kološ
“Well, I think there probably was a difference related to the previous regime. Under communism people were shy to speak and they didn’t want to talk too much.

“Also talking to patients was the privilege of heads and bosses, rather than ordinary doctors. But I’m sure the situation is gradually changing.”

Is there a different attitude to doctors among the public in the Czech Republic and in the UK?

“Maybe I’m not going to answer your question directly, but there is a significant difference. I tell you what I think: Primary care in the Czech Republic is probably better than in England.

“I understand that historically the GP is very important. But I think nowadays there is more need for specialised doctors and the system in the Czech Republic is brilliant.

“I think the primary paediatric care is brilliant. I don’t think that all GPs can manage to be well up to date on all issues related to obstetrics, paediatrics and internal medicine.

“I think primary care in the Czech Republic is easier to access. The system is the same, so it’s free of charge, more or less. That’s the advantage of this system and they should not destroy it.

“Now to your question, I think Czech patients are still used to seeing doctors as, I wouldn’t say gods, but they have great authority. They have great respect.

“I think parents here in England consider doctors as partly partners, but partly they are quite demanding sometimes. They come and they want to be provided with the best possible service.

“One thing that I quite like is that we very often call people by their names, rather than their titles. If I have chronic patients and I see them very often, we have a quite good relationship.

“Treating a child with congenital heart disease is more on a friendly basis. That’s something that we probably don’t see very often in the Czech Republic.”

So nobody’s calling you the equivalent of [typical Czech expression] “pan doktor”?

“If I translate to English – Mr. Doctor – that sounds a bit funny, doesn’t it?”

I was surprised to read that here at GOSH there are facilities for families to receive counselling or help from psychologists. Does that also exist in the Czech Republic?

Motol Hospital,  photo: Kristýna Maková
“Psychology is a well-recognised discipline so I’m sure there are many psychologists who help families.

“I think the system is probably better developed here. And it’s not only support from psychologists but also from advanced nursing staff.

“Because I am dealing with a disease that unfortunately we can’t always cure and unfortunately some children may die, we have a very good support system which can actually stay with the family and help them until the end of the life of their child.

“So I think these support services are better developed in the UK than in the Czech Republic.”

Do you ever get Czech patients here?

“Yes, we’ve got a few patients. The first are Czech patients resident in the UK.

“We also have very good collaboration with Motol Hospital and sometimes I help with second opinions. But routinely all patients are treated in the same way in Prague.”

London is of course an extremely multi-cultural city. Was that something that you had to get used to – interacting with patients from all kinds of cultures and from different countries?

“I very much like it and got used to it very quickly. I’ve always been keen to meet other peoples and learn from other cultures.

“I was partly trained in Texas in the US and in Canada and I actually appreciate very much living in this culturally rich city. It’s amazing.”

There is something of a Czech community in London. Is there a Czech medical community?

“Not that I am aware of. I know a few colleagues who are working in London but in fact we don’t really communicate very often.

“In contrast to the Polish population, I think the Czech population is quite small, and we don’t routinely communicate.”

I was reading a statement from you in which you said that you like to pass on knowledge to the next generation of doctors. Have you had much opportunity to encourage young Czech doctors?

“Yes, actually. We have a very good programme with the paediatric heart centre in Motol and we started I think five years ago with Professor Janoušek, who is currently the head of the Prague centre.

“I have already trained here more than 10 young doctors and students. I am also inviting senior colleagues to give talks and presentations. So we have very good collaboration.

“We are also establishing some research programmes. So since I left we have had quite active collaboration.

Illustrative photo: Filip Jandourek
“And I don’t want to disconnect from the Prague unit, because I feel partly obliged to pay back what I received from my mentors. That’s very important, I think.”

Can you imagine in the future returning to Prague permanently and sharing your know-how in that way?

“I am used to going back and presenting. I’m a professor at Charles University, so I also have a link to the First Medical School in Prague. I give talks three or four times a year.

“I’m not at the moment planning to return. But you know I’m not so young any more so maybe when I retire in a few years’ time I will consider going back, yes.”

You spend some time in Prague but you live here in London. Are there things you miss about the Czech Republic?

“I miss the countryside. I’m a quite keen cyclist and instead of trying to go somewhere outside the city here, and because I travel a lot, I spend all my annual leaves going back to the Czech Republic, but not necessarily to Prague.

“We have a beautiful place in South Bohemia and with, I think, 12 families from Motol Hospital and other places we’ve been having reunions there for the last 15 years.

“So if you ask me where I usually go for holidays, it’s always Southern Bohemia.”