Interview with Dr E. Thervet

Dr E. Thervet Service de Néphrologie Hôpital Saint Louis Paris, France

Zoccali: Dr Thervet why did you decide to specialize in nephrology?

Thervet: Different reasons have explained my decision to specialize in nephrology. Firstly, during my first years in medical school, I had the opportunity to meet very talented nephrologists and their personal influences were important in my decision. The second reason is the intellectual challenge that is included in every single renal patient regarding the diagnosis of his renal disease and the best treatment available. Finally, and possibly the most important reason, is the possibility which is offered to any renal patient to survive even after his kidney function has definitely failed. It is one of the major breakthroughs of nephrology to different supportive treatments, chronic dialysis or renal transplantation.

Zoccali: Could you briefly tell us how training programs in nephrology are organized in France?

Thervet: Training programs for nephrology last 4 years in France. Training programs for nephrologists have dramatically changed in France during the last 10 years. Ten years ago, training of young nephrologists was almost only performed in Nephrology units including bedside rounds and a more theoretical approach.
During the last decade, teaching of clinical nephrology and basic science has been developed. The training is organized both by regional and national organizations. Young nephrologists attend the seminars during which highly qualified nephrologists give them the latest update in all aspects of Nephrology including specific topics such as transplantation, hereditary renal diseases, etc.
Young nephrologists are also invited to attend national and international meetings in order to present their work and to participate in the life of the nephrology community.
Finally, most young nephrologists are invited to have a comprehensive view of basic research for at least one year during their training. They are integrated in various research labs. This year gives them the opportunity to understand the specific challenge of basic research and shows the methods for critical review of scientific literature.
All these educational programs are associated with the clinical work in various units among which young nephrologists are integrated in a clinical team. Young nephrologists are due to spend at least half of their formation (2 years) in clinical units.
Taken together this new approach for training programs has permitted to improve the training to the high level required by the international neighborhood. This improvement has been associated with the preservation of good quality in clinical practice.

Zoccali: Would you make the same decision now or do you feel that other specialties offer better professional prospects?

Thervet: I would make the same decision since nephrology has integrated new knowledge, such as molecular medicine and cell biology in the clinical practice. Therefore, nephrology remains an appealing specialty.

Zoccali: How many hours a week do you work?

Thervet: I work around 70 hours a week including laboratory activities, clinical duty, publication, and teaching.

Zoccali: As you know, a debate is ongoing in Britain and in the USA on the high workload of junior doctors in those countries. Do you think that a huge workload is really necessary for a young doctor to mature solid experience and the necessary endurance to face successfully the professional and personal challenges of clinical medicine?

Thervet: I believe that medicine has always been a challenging area and remains so. It has become maybe more challenging. Indeed, doctors have to integrate both scientific, clinical and ethical issue to take the best care of their patients. The continuous improvement in biologic science has challenged all the medical community because of the need to follow closely the medical knowledge. The role of continuous medical education is now crucial. On the other hand, the patients and public authorities are more and more implicated in the choices regarding the public health system. The only way for junior doctors to deal with these new demands is to be mature and to have the endurance to achieve their role as clinical doctors and members of health professional. This challenge makes this profession even more attractive. The dark side is that only a huge workload may answer to the different challenges I have described.

Zoccali: Have you done or planned to do a work experience abroad? How important is it for a French doctor making an experience abroad? Is this considered an important element in a professional curriculum?

Thervet: I have worked in UK in a nephrology unit as a senior house officer. In France, the experience abroad is now considered to be crucial for all young nephrologists. This experience is also of utmost importance in a curriculum. However, I think that the majority of the young nephrologists have spent their experience abroad in a research laboratory. I believe that clinical program of exchange among EC should be encouraged because the vision of different clinical approaches may be of great value for a training nephrologist.

Zoccali: Which is the research question that presently intrigues you most? Which project would you like to start?

Thervet: The research question that intrigues me most is predictive medicine. I strongly believe that individualization of the diagnosis, treatment and follow-up will become more and more important in clinical practice. I am confident that the improvement in molecular medicine including genetics and genomics will help to take the best care of an individual patient. I would like to start a prospective project using this approach to choose the immunosuppressive treatments used after renal transplantation for a specific patient.

Zoccali: What disappointed you most during your training years?

Thervet: During my training, I was amazed how the clinical management of renal patient was not done using evidence based medicine. The decision remains more on clinical experience of senior doctors. Clinical approach in nephrology, including randomized study, has been long to develop when compared with other medical specialty, except in renal transplantation. It is probably my most important disappointment. However, I feel that this is changing and rational approach is becoming more important.

Zoccali: What rewarded you most during your training years?

Thervet: The first time I was directly responsible for the cure of one patient. It is the most rewarding feeling as a medical doctor to feel that your choice has been essential for patient healing.

Zoccali: Which are your hobbies?

Thervet: I play golf and I practice jogging. I often go to the Opera because I believe that this is the most achieved form of art. I read a lot.