Bilgin Timuralp

Facts for patients, physicians and institutions

We can come close to the truth only if we put ourselves in the shoes of our patients and their relatives. This is true for many health issues and diseases. I often tell medical students, “Behave toward your patients just as you would like other doctors to behave to your mother, father, spouse and children.” Of course, affection and integrity come first. Even if a physician manages to make his patient arise from the dead “by catching lightning in a bottle,” he is not remembered with gratitude after all, unless he acts with the necessary affection and integrity during that time. On the other hand, your patients whom you tried hard to treat by acting with affection and integrity feel gratitude and appreciation towards you after all, and they even invite you to the funeral and Mawlid ceremonies (for patients’ relatives, deaths are the charge of physicians and survivors are the charge of God). I ask a grandchild whose grandfather and father died in my hands during over half a century of my profession of a physician, “All of them slipped through my hands, why do you still come for treatment?” If you act with due integrity and affection, you can find your real place in life and in your conscience. The medical profession is not as easy as it was in the old times. In a sense, there are so many devices that decide on your behalf. They will almost substitute for you due to their mystery., although they were created by people like you. These devices are now sharing the reputation and mystery of physicians. Foreign words told by physicians at bedside and even physiopathological descriptions that you make with your best intention and effort, but still remain a mystery are adequate. However, patient relatives used to consider you quite knowledgeable and mysterious since these words were not understood in the past. Now, well-intentioned people who stand in front of you and ask, “Have you read this?” explaining the breaking news in the newspaper clippings are not lower in number, but internet information pollution is present, and physicians are now questioned more in some countries. This is done, for example, in Turkey, by magician-scholars who do not miss any opportunities. Eliminating these misbehaviors is the responsibility of governmental institutions, professional organizations, non-governmental organizations and physicians. If I say, “Don’t eat fatty and salty food!” in the media, people take this knowledge into consideration, but do not like it. They really feel blue because of the food they see offered to them. Well, who says this? Physicians. All truth is actually not always meant to be told. In my opinion, these rule-making, limiting attitudes that make life tasteless, leave people hungry and living a dog’s life underlie some of the attacks against physicians. According to one of my close acquaintances, physicians are more vulnerable to attack for these reasons. However, an ‘insane’ person leads citizens in many countries, and just as he brings these countries to disasters he says, “You will die in the absence of cholesterol,” and dares to drink olive oil on TV and recommends nondescript diets. Now this topic is out of the question. Half a century ago, I saw that my elderly closed friend who was a great physician brought ‘water’ from the Damlataş Cave in Antalya for the treatment of his diabetes mellitus, and I was quite surprised. In those years, a headline in the highest circulation newspaper of the time announced, “Honey is good for diabetes.” In a couple of weeks, those who stopped their diet were taken to emergency services due to hyperglycemic coma. The individual who was responsible for this was probably sunbathing on a chaise lounge. Again, in those years, when acetylsalicylic acid was proven to be beneficial for atherosclerosis, aspirin was out of stock in many countries. What about the end of this issue that became a cover page headline in TIME magazine with inadequate information? Well, after a couple of months, ophthalmologists began asking, “Why have retinal hemorrhage cases increased in the meantime?” Though considered to be a similar situation, we were never surprised by the patients brought to the emergency services due to gastrointestinal system bleeding cases on the first and second days of Ramadan and Sacrifice Feasts, nor we had any questions about them. As a result, primarily the government pays for the complications that result from patients who are still self-prescribing and taking aspirin in Turkey. Well, to what extent are the necessary education programs and precautions are implemented in return for this? Mind you, how many times have the world’s most esteemed governments and their cardiology societies have changed their consistent, essential, precisely delimited rules about aspirin for primary protection against atherosclerosis several times over the last few years? Remember this. All these cases harm not only physicians, but to the profession. To prevent these cases, whoever is responsible should be provided with higher duty limits and given more authority; however, they should also account for these cases, they should not be told, “You’ve made your bed, now lie in it.” If the press members aspire to sell themselves instead of you, the physician, or those who are responsible for these cases aspire to sell themselves instead of the patient, I am sorry for the students whom I supposed I had trained. Shining horizons are ahead of us.

Fifteenth anniversary: Author-reviewer-editor in scientific research

The Anatolian Journal of Cardiology’s March 2016 issue comes after fifteen years of adventures. The position it has achieved in this time is still judged by many academicians to be “a miracle,” “a great success,” and, “a wonder.” They are saying, “Bravo!” and describe it with words like splendid, superb and esteemed. To me, the reason for the journal’s success is reading very widely, reviewing and using the mind. The other contributing causes are human factors. I envy the Journals of Circulation or JACC and approach them with respect and a bit of envy, so we will not consider this evaluation of AJC as my human emotions and a natural and expected opinion. This is not a case of, “Even a single rose from my friend wounds me.” During these years, I have met so many esteemed academics, young and old, Turkish and foreign, that my world has actually been changed. We began and were suspended from the university. Gulmira left, and my rector Fazıl Hoca and my friends enabled me to return to the university. We were cheated and conspired against. As a consequence, I and the team of Editors, who devotedly contributed to The Anatolian Journal of Cardiology, have been honored. I must say that I gained this honor with our authors and reviewers. Here’s to another happy fifteen years with our Editor Prof. Dr. Zeki Öngen. *** Good research can only be accomplished by a good and perfect researcher. Both research and researcher achieve excellence by overcoming impossibilities, challenges, obstacles and disappointments. Researchers’ greatest strengths are curiosity and the desire to learn, to know, to experiment and to put scientific results into practice. They are led by the mind. They evaluate events, texts and experiences evenhandedly. The greatest, most significant and difficult algebra equations have started with the foundation, 1+1=2, and thus attained the highest position in math (for the time being). In addition to these factors in development of the mind, a good work environment and having the skills of the time are the keystones of good research. Not using the mind and believing rumors, myths, stories and tales is nothing but cutting corners and laziness. People, who are unable and uneducated when they are born, gain strength and establish their own identities. If this development is limited to what teachers and family members teach them, their future potential is shaped accordingly. If these are not examined, that person will not be able to go beyond the level of a researcher candidate. If scientists do not put the questions Why? How? and What if? before their emotions, they will never be able to go beyond being a servant of society. Accepting things is the easy way. Do so, and you won’t get in trouble. If this is your self-identity, you live in the class of happy people with strong and trouble-free emotions. Considering cases as problems and being curious about them, trying to understand them, knowing and discussing them is tiring for these people. On the other hand, people with the desire to know, to learn, to experiment, to wonder and to analyze will find it difficult to be happy, sleep well and find peace. Since finding the answers to questions will be scientists’ happiest moments, they will taste the sense of relief. If people experience the efforts of curiosity and analysis as torment, they will be unsuccessful and will not be able to enjoy the solutions they reluctantly achieve. If they acquire a position, an office, a reputation or money, it means for them that the goal has been reached. They will no longer need to suffer, to observe the questions and their askers, to find solutions, to experiment and to repeatedly examine and research their findings. But if they felt the need to do so, they would turn out to be like Aziz Sancar. A brave, heroic and devoted researcher should see and know the factors and obstacles mentioned above and achieve results without giving up. If the action of knowing is conducted with the mind and the knowledge of the mind is examined on a solid basis, its value is appreciated even if it arrives late, and new facts are generated on the basis of that knowledge. Adding new facts to the facts and solutions to which we are accustomed or accept or confuting these facts would be problematic either way. When Einstein realized after decades that a theory of his had been wrong, he stood up, confessed, notified the science world immediately and presented new ideas. If the inventions and genuine results are verified by somebody else after a good analysis with same subjects (humans, organisms or objects) and methods, these inventions and results are potentially laws of science. People would be happy with such inventions. What if their hypothetical research question and construct proves that they are wrong? That would be another significant invention. As a result of their effort and research, they present the caveat, “With these subjects and methods, only this result was achieved” to the succeeding researchers. In addition, if they test established knowledge and find something contrary, they will experience problems. Humans are helpless servants. Even if you win a Nobel Prize, what you know cannot surpass what you do not know.