Professor Bari Ferenc: Being a doctor is not only a profession but also a lifestyle
In autumn during the Alumni Reunion event we had organized a friendly soccer game between teachers and students. To our great surprise, when Prof Bari arrived he asked to join the teachers team. We were even more surprised by his agility and skills on the field. He is well known for his openness to students and new ideas, and his eagerness to constantly look to improve things at the faculty. For the interview he greeted us in his typical friendly manner and good mood. He was happy to share memories from his life and his ideas on improving the faculty.
Could you tell us a bit about your background professor, where you grew up and how you decided to become a medical physicist?
I was born in a lovely city at the river Tisza called Csongrad. I was educated there and I got a lot of influences, because it was a very nice schooling system. I went to music school, and enjoyed art – it left a deep impression on me. I also attended a drawing club, so therefore my favorite stuff is always art. When I was in high school, I participated in many mathematics and physics competitions and I became the member of the Hungarian Olympic team for physics and won many, many competitions. I was interested in many different directions, but at that time, studying electrical engineering and biomedical engineering was a very nice thing and we didn’t have any physicians in the family so I decided to study in Budapest. At university, I joined a TDK-group where we studied flow measurements, and I did my thesis in the central army hospital where we measured ECG and EEG signals trying to do some data reduction – at that time computers were very new. We tried to do something with these signals, for example how to acquire the relevant information. At that time, my sister studied here at the University of Szeged, in the Medical Faculty, there was a vacant position in the Department of Physiology and I came here for an interview and joined the department.
After that, I spent 31 years in the Department of Physiology where I became a full professor. We studied, with Prof. Benedek and Prof. Obal, the sleep-wake cycle and thermoregulation. Based on these studies and research I got the opportunity to spend two years in Germany. It happened 26-27 years ago, so it’s a long time ago. I worked at the Max Planck Institute (Max Plank Institut fur Biofysik) near Frankfurt. There I did research on the nasal microcirculation and thermal exchange in the nasal pathways.
When I came back [to Hungary], I was able to set-up a microcirculatory laboratory. In the early ‘90s, we started to study cerebral circulation. Since then I’ve focused on this topic.
After that I spent three years in the United State of America, working in Winston-Salem, North Carolina. I got a full-grad scholarship and made progress in the cerebral circulation of the newborns. We used various types of animal models and studied hypoxic conditions which are very dangerous in the perinatal and early post-natal life.
I was appointed full professor in the field of physiology in 2002, but my interest was always in developing of new methods for measurements of the cerebral circulation. I’ve been using optical methods for 20-25 years and when Prof. Hantos was retiring in the Department of Informatics, they asked me if I was able to replace his post, so I decided: “Well, why not?”! An agreement with the [former] Dean, Professor Benedek, was made to create a new department which would also include my field, Medical Physics. It was a bad structure at that time because the medical faculty didn’t have any actual Department of Physics, and as medical techniques were developing so fast this vacancy should’ve been completed sooner.
You all know the story, because you’ve been tortured in this field of physics!
Students often dislike physics, while some find it interesting. What’s your opinion about this?
Sooner or later you’ll understand that life sciences include everything. You can approach life from a biological point of view, cell biology point of view, from anatomy, from physiology, but physics is involved everywhere. You are using devices that are very complicated and sophisticated and if there’s no separation between the experts of physics and life sciences, then you can’t make new devices. On the other hand, life can be described by physical principles, or life can be quantified by mathematics. And if someone dislikes this, because he or she is not knowledgeable, then this is a big discrepancy.
So would you say that physics is the basis of medicine?
From where does the English name of doctor come from, physician? From physics obviously!
What can you tell us about the school you went to for music and art?
I realized I wasn’t talented, but I enjoyed it. Of course if I drew, I enjoyed the things I made. I have many friends in this field but this was a very basic education. I knew a lot about different composers, listened to many classical masterpieces. It was very nice. I’ve also done a lot of sports. Of course you can’t recognize it anymore on me, but I did a lot of ‘track and field athletics’.
Did you ever learn to play any instruments? Any favorite?
Yeah, I learned to play piano and clarinet. I don’t have a favorite, but as I said, I recognized at an early age that I wasn’t really talented in these things even though it was good to see my limits. I think it’s a good thing, to understand what your talents are and what are your boundaries in this aspect. It’s the same with sports, because if you don’t actually ‘do it’, and only watch, you’ll never know what is easy or fun for you. People say tennis is easy, but if you spend 4-5 years playing tennis, you’ll understand where the limit lies. It is important to understand at an early age where your own limits are positioned, but certainly it also adds to life experience.
What sort of things do you do outside of work?
I like to read a lot, autobiographies, novels and so on. I read world literature but also Hungarian literature as well. Contemporary writers who fascinate me, Spanish writer for example Javier Marias, or there is a very good Norwegian writer, Per Petterson. I also like the Japanese novelist Haruki Murakami. I read a lot, because I like to keep my mind fresh.
When you went to Budapest, which courses did you study?
I studied electrical engineering and there was a specialization for biomedical engineering and measurement techniques. It was good, it was a nice life and I enjoyed it very much, though it was very challenging as well. It was the biggest university in Hungary at that time and I went onto a special “track”. There were only 15 people in one group and each one of us was taught individually.
When you went to Germany, how did you experience moving from Hungary to Frankfurt? Was it a very big cultural shock?
On one hand yes, because at that time the political situation was quite different. I spent one year alone, I left my family here. At that time we only had two children. I had to learn how to survive, how to be effective alone, so it was hard. The second year we spent together, but it was very useful, because my daughter went to elementary school in Germany, my son went to kindergarten there. They both picked up the language very fast and it was important to see how adaptive a family can be. Of course it was challenging to live in Germany, because on one hand, the standard of life was quite high, but on the other hand, we were foreigners there.
Did any part of you want to stay in Germany, or were you happy to come back to Hungary?
I only had a contract for two years. My mentor offered me devices, actually he was almost retired so we moved half of his laboratory to Szeged. I was able to continue my work here in Szeged, with not exactly the same equipment, but similar facilities. Therefore, coming back wasn’t so bad. I kept in touch with my mentor afterwards for almost 15 years and we visited each other, so I had a good connection with him.
How about when you went to the US?
I love the States, because my best research time was in the States. Almost unlimited resources, very friendly environment and I had very good connections. And at that time we were at the top – maybe the best in the field of cerebral circulation in the world. It was very challenging and demanding, but I enjoyed every minute.
In 2 years, we published more than 20 full papers. It was not a one-sided connection, but very beneficial for American partners as well. Since then, I’ve always had someone from the laboratory in the States. More than 20 years have elapsed and even now there are two colleagues there with whom we keep contact. I’m not involved at the moment with the papers because I can’t work effectively now but young people are spending 1 or 2 years there and many of them are returning.
Did your family go as well?
Yeah. I was there with my family and my children went to American schools, and it was very useful because they learned how to behave in those schools. It was a great time. My daughter always got “A’s” in class. She received a nice letter signed by the President of the United States of America at the time, Bill Clinton, which said “Congratulations”.
Did your children enjoy their time in America and do you think they wanted to live there?
Oh yeah, they enjoyed their time overseas, but I don’t think they wanted to live there permanently. We had to decide – when you’re settling down in the States, especially when you are in the academic field, it’s not difficult. However, making money for a living, for a lifestyle characteristic for an academic person, is almost impossible. Buying a house, educating our children and so on, requires more effort. On the other hand, my wife is an ophthalmologist, she’s an associate professor in the Department of Ophthalmology and for her it was almost impossible to do the USMLE at the age of 40+, starting something from the very beginning. She’s a great eye surgeon, so why not practice her profession here in Hungary. In the States, you are only working as an assistant. However, I made very good money in the States, but when we returned it was difficult because the income was less. I’d say living in the States was good.
While there we didn’t have much opportunity to travel. In the first year I only had two days off. But in the second year, especially at the end of this mission, we travelled a bit. Also when I went back to the US a few times, I had opportunities to travel throughout the US. It was beautiful there, besides, we lived close to the Appalachian Mountains and Blue Ridge Parkway if you’re familiar with it. Whenever you’re there you should definitely visit the Outer Banks, which is a row of small islands off the coast of North Carolina, basically forming a barrier between the Atlantic Ocean and the US mainland. Simply beautiful.
Do you miss any foods or activities from America?
We’re adaptive. Anywhere you live in the world you can find good food! 🙂
Did you get any chance to teach there in the States? To be a mentor for students during your time in North Carolina?
I participated in education, because I worked for the Department of Physiology and Pharmacology, so we had tutorials. At that time we practiced “Problem-based Medicine” which was a certain teaching system. I also spent time teaching whilst I was in Germany. Besides that, I’ve been part of the team involved in post-graduate training. I have mentored here more than 80, almost 90 students who won prizes in student competitions. I have a lot of pupils around here.
Speaking about problem-based learning, there are many universities doing that already in medical studies. Do you see the University of Szeged, starting to do such courses?
There are many ways to train good doctors. The way we do it at the moment is not bad at all. There are of course “popular” methods and problem-based learning is OK if the student is spending a lot of time on his or her own. In this case you have a problem, maybe you get an x-ray picture, a case history and an anamnesis. You sit down with a group and start to figure out, what the disease was and what the treatment was or was supposed to be. But in order to do this, you need a lot of time and a lot of devotion.
Our system is a bit old-fashioned; basically we are forcing the students. It’s a shame. You are young adults so why should I force you to learn? We started to make changes and the voluntary clinical work here, which can now be taken as a course, is something which could help. I guess that if you would like to be a doctor, the best way is to be immersed in real-life situations as early as possible. Even in the first year when you go to internal medicine or surgery, you see people – you see patients in their bed. You can help in nursing and in daily activities. If you are exposed to this environment, you can make good decisions earlier whether you would like to be a pediatrician, or a radiologist. If you like to do something like surgery or anything related, you can check your abilities. I guess this is some sort of maturation. Also, you have to learn how to behave like a doctor.
When students are now in 5th or 6th year, they understand that those students in first or second year are behaving like children. And being a doctor is not only a profession but also a lifestyle. You are role models for people, how your clothing is, how your behavior is. And the bad side is that you can learn more within 2-3 days, than having an easy course. Now I guess that this year about 85 students took this voluntary clinical course, but I would like to force the system towards this. I guess that students should spend more time in hospitals in my opinion, and not in the lecture halls. It is again a decision to be made. If you sit down and listen to a lecture, you can pick up a few messages. However, if you look on internet and YouTube, there are a lot of things you can learn. However, true experience is obtained bed-side, if the patient requires your help you understand what you need to do and what your mission is.
Would you say that this newly introduced course for first year students, could change the way of teaching at the University of Szeged in the same way as the methods used in the United States?
I’d like to emphasize that we have to share the responsibility. Our responsibility is to provide and deliver valid knowledge. It’s OK for all departments up to that point. All the departments are teaching state-of-the-art and up-to-date science. So I don’t think any old-fashioned department exists here at the University of Szeged. The other issue however, is if the students don’t understand that it is not our total effort to force them to study, because it is their own life. The other big change is the complete skill set. We will put a huge amount of money into the skill sets in the upcoming years to teach the students what’s right for them. Another new thing I guess is that we are making big changes in the clinical education. Again I have to say, that without the students we can’t do it. Without them, we are just wasting efforts and our good intentions.
The other issue is that you have to decide, either you would like to be doctors in Hungary or you would like to work abroad. To be a doctor here, you have to learn Hungarian – of course it is a huge dream that the Hungarian patients will speak English, but no, they won’t. You have to make contacts, but I guess at first glance, speaking Hungarian is useless. On the other hand, if you learn another language, you will be a quite different person intellectually. You will understand many new things, many nuances. If someone wants to train somewhere else, we are accrediting hospitals all over the world where students can practice.
With regards to the current examining techniques, do you foresee any changes for example, more written exams?
Let me reassure you, that we know all the methods, all the methods all over the world. With six colleagues, I went to the annual meeting of the Association for Medical Education in Europe (AMEE), and there were 3,500 people from all the corners of the world talking about methods of medical education, so we are aware of it. Of course, some of the people prefer the oral examination, and I don’t know what that means exactly because it’s a funny situation. When a group consisted of only 20 or 30 students, it was an excellent method. But having classes comprising of several hundreds of students, perhaps up to 300 pupils is a different situation. When there are only four or five examiners, then the chances are not equal for each student. If you start the examinations at 9AM, the teachers are going to be tired in the afternoon and the students who didn’t sleep, nor eat or drink are quite different at 9AM and at 3PM. Everyone thinks this is a good method. For me it’s a good method as well, but I see the drawbacks.
We have to check the factual knowledge, for this purpose all over the world, MCQs [multiple choice questions] are used. Of course it would be more elegant to have more essays which is more comprehensive in terms of knowledge. But have you had a chance to see all different types of handwriting? It is sometimes just loose keywords, without verbs or whole sentences. So we can’t really communicate in these ways and both communication skills as well as knowledge are very important. Sooner or later, modern devices will make up and replace most of the tasks of the physician’s job; similar to aviation nowadays where computers can fly airplanes through so-called fly-by-wire technique. However, the human factor will remain. You, as a physician, will still have to calm down the patient, reassure him or her and give advice. You have to handle the fear, the pain, the sorrow. The personal part of medicine cannot be neglected. For that we also require players from the other side. We have to bring the students to the bed-side and show them the patients are suffering, that people have social problems among other things. They look at you as a doctor of the future, as a medical person and they need help. This aspect should be emphasized in medicine from the early beginning. The Emergency Department takes a lot of students and tries to help them to understand these situations.
In the normal curriculum, one third is dedicated to behavioral sciences and currently if someone fails in psychology, everyone is laughing. But if students don’t put effort into learning things like taking a patient history or how to handle or setup a case report etc, they won’t know how to deal with human factors, thus we want to put more emphasis on it.
Do you have any advice for the current students?
Life is very short, take this very seriously… and play a lot. This is another controversy. You like to be a doctor, but please make all the effort to become a good doctor. Because if you are a good professional, it makes you satisfied. So don’t worry, you’ll get a job anywhere in the world because there are shortages everywhere. It is not a question, whether you can live from your job or not. The question that remains is the quality. I guess if you know what that means you can gain a lot. The only limit is the sky. Almost all the knowledge is available on the internet, everything can be studied, just be confident that you can achieve it and do it. Passive attitude is a pain. If you don’t know something, it is not a problem. Every day I learn something new. Even learning can be enjoyable. If you figure out something new it is a small piece of a larger puzzle, which you are putting together. As a medical doctor you have to be prepared to learn new things every day.
We’ve spoken about things that are going to be changed in the university. And you started to implement those things since you were appointed as the new dean since last year. How do you see the university in 5 to 10 years from now or by the time you finish your deanship? What are the changes you would like to see and how do you foresee the future for the medical faculty of the University of Szeged?
First of all we need a lot of money for changes to be made. But money itself isn’t everything, we need to make good proposals for good projects. My preference is having good people as well. And having good people is maybe the toughest part of our lives because good positions are offered all over the world. When you are training good doctors, they are going to be more valuable in the market so therefore we have to prepared that it’s a huge competition for the good people. Therefore we have to make good offers for these people. Secondly, the good thing about the medical faculty is that it’s located in the heart of the city, but at the same time it is also rendered as a disadvantage. The old buildings need a lot of money for maintenance and renovation. It was very good having free land and start building new buildings, however there isn’t any in the downtown.
The good thing is, that we’ll have money for reconstruction and renovation of the older buildings, so from next year the surgery building will be first. We will put a huge skills center there and a center for excellence, which means for science.
In two years there will be the development of an emergency department for children. From that moment skyways will connect the Emergency, the Oto-Rhino-Laryngology and the Pediatrics Departments. These are definite plans, we see the developments of these projects. Also, I would like to incorporate into these plans a nice cafeteria and a big education building. If I can achieve half of it, I will be satisfied. We will try our best and work hard.
The new building that now includes 700 hospital beds is a very modern hospital, so it is no question whether it is state-of-the-art. Every visitor who comes here and sees it, says that is high-tech.
On the level for the students, how would you like to see changes and how would you correlate this to the reputation of the university?
Again, this is not only our job, but also of the students. There’s a huge competition within Europe for good or better students. If we can recruit better students from the very beginning, we can put more and more efforts in encouraging the talented ones. Now half of the efforts are put into helping the “slower” students, so you cannot imagine in how much energy is put into repeat-examinations/retakes for basically nothing. When I was a student, I knew my knowledge. If I was not ready for the exam, I simply didn’t go. I guess that everyone can make a judgment within a one-mark range. Of course if you get a 4, but maybe your knowledge was worth a 5 or when your knowledge is valued a 4 perhaps it was only worth a 3. But having just a “trial” exam for nothing, how much effort is wasted?
Last week I spoke with Prof. Burian, who is the head of the Microbiology Department. She informed me that they had 1400 examination opportunities for the 400 students. Meaning that for every student around 3 possible occasions were offered, which is a somewhat stupid thing.How much effort should be put into this? And if you just regard the fact that teachers had to take time out of their work and research to make space for these extra exam days. The reputation of the Faculty of Medicine is also dependent on the students. What is the message? If you blame the school, it is a bad message.
In comparison, I know, our school is very good. Now we have an international semester which many have no clue about yet. Five years ago, we started a trial with two French universities, two Romanian, one Italian and one university in Amsterdam (Vrije Universiteit Amsterdam). In the 5th semester we select students to study together with those from abroad. Four editions were done in France, two of those were in Nantes and the other two in Angers. Now this course is here in Szeged, and we are almost finished with it. And believe it or not, everyone is very satisfied. We are able to deliver the knowledge. Of course technically the school is not good, bad roads, old buildings and so on. But you won’t find much better facilities in Italy or in Spain. So this is the reality. If you compare with the UK or Germany, there’s a huge difference. But compared the rest of Europe, Greece, Romania or even Czech Republic, we can have the same level.
If we can convince young people to join our departments, then it is beneficial for both sides.
So you think recruiting better pupils is the solution to this?
Yes, this is always the solution. If you put the illusion in the very beginning that nothing is needed, just money, then there will be problems. If students want to become doctors, and they need to work hard, and if they can’t do it, then do something else. So another aspect is how to bypass students into other directions and careers. I’d like to have and provide more ways. For example, if someone is failing here in the medical faculty, maybe he can learn molecular biology and do a bachelors or masters later on in biology or physical education, which is close to the medical profession. If someone is failing here, can he or she do it? Of course he can go to another university and try there, but will he or she succeed? Medicine absorbs/comprises many professions of the health sciences, if you are a good nurse in anesthesiology, you can be useful part of the medical team. So we have to help the struggling students as well, or those who are not able to meet the set requirements.
Thank you Professor Bari for taking time out of your busy schedule to take part in the Interview Series. It has been very interesting and fascinating to hear about your exciting career. We’re sure all our readers will enjoy hearing your story, We know we certainly did!