Interview with Jan Strojil, Faculty of Medicine & Dentistry, Palacký University, Olomouc

Can you tell us a little bit about your respective roles? What is a typical day like for you?

I don’t have a typical day and that’s what I love about being a clinical pharmacologist. I have many roles that compete for my time. I like to think of myself as a teacher first, then a physician, scientist, and manager (if I can call it that). Teaching is my passion; it’s what recharges my batteries and what I consider has, by far, the most impact. I teach them to respect drugs and always be a little afraid to prescribe. I teach them to look for quality of life and survival benefits, rather than treating laboratory values and meaningless numbers in the computer, which is a hole we all so readily fall into. I like to think that by passing on some of the excitement and wonder that got me into pharmacology, I indirectly affect patients’ lives more than I ever could as a practicing clinician. Which I still am, our clinical pharmacology unit provides consultations for the hospital, mostly TDM, but also a lot of adverse effects, polypharmacy reduction, DDI, whatever question the attending physicians may have. Just as teaching, this part of my job keeps me in touch with all fields of medicine, from obstetrics through pediatrics to geriatrics. Science comes in third, but unlike teaching and patient care, which have set time schedules, research always was filling the gaps, evenings or weekends. With two small children, it has become more challenging to find the time. Another role I have taken up few years ago is chairing the faculty Academic senate becoming the youngest faculty member to do so in the history of the university. I have always been interested in how the school functions and this allows me to be involved and give back to my alma mater. But it is a serious time and energy eater.

Is there anything that your laboratory does or that is done at your hospital that you would consider innovative?

The tradition is different in each country, in each hospital. Our department is unique in the sense that we have four MD’s providing clinical pharmacology services to the hospital. As far as I am aware, we are now the most active department in the country when it comes to hands-on patient care. I have utmost respect to our pharmacy colleagues but I believe that our training in internal medicine puts us in a special position when it comes to consultations and allows us to comment more on differential diagnoses for example. Also, it makes it easier to get physicians to accept our recommendations, as we are seen more like peers. (It pains me to admit that many MD’s look down at pharmacists in our country.)

How did you become interested in your area of expertise?

I decided to specialize in pharmacology after I graduated from medical school because in my studies, it was the first subject I remembered enjoying. I found it a logical extension of physiology, which I loved. And it was the first one I found useful which made it so much easier to study. Since TDM is a large part of the clinical service we provide and given my limited but unusual-for-an-MD background in maths and programming, it logically became one of my main topics of interest. Our close ties with microbiology mean antibiotics were a logical choice.

Is there anything that you’ve seen elsewhere or heard about and thought “I’d like to incorporate that idea at my center”?

Most definitely. Be it teaching – better multiple-choice tests. The way we do student assessment has been my pet peeve since I was a student. We know we do it wrong, we know there are better ways, yet there is huge resistance to change. Same thing with teaching teachers to teach. We still believe that is someone is good at what they do (medicine, science) they will be good teachers. This leads to many unhappy teachers and many unhappy students. There are schools we could, and should, learn from.

For TDM, we should more aggressively push for earlier consultations. We are making progress in this respect and are seeing fewer and fewer “gentamicin on the 8th day” requests and more first day or even initial dose requests. But it’s a long run: changing peoples’ behavior is one of the hardest tasks.

What sort of research do you have on the horizon that you think might influence clinical practice in the future?

I am currently involved in research on TDM and dosing of beta-lactam antibiotics. If it goes well, we could contribute one tiny piece into a huge puzzle that seems to be telling us we can do more for our patients. I also have a previous project that I did with a student of mine who focused on risk perception and adherence in patients on Gleevec (imatinib) and other tyrosine-kinase inhibitors. There is no problem in medicine that would promise better return for effort invested than compliance. Yet, we seem to strangely ignore it, developing better and better drugs that half of the patients end up not taking.

What do you consider is the future for TDM and CT? What are you excited about? What are the challenges we face?

I am excited to see that the prevailing mindset that TDM is a problem for a drug rather than an opportunity to make it better is finally beginning to change. With new analytical tools such as rapid bedside measurements using a single drop of blood, we may be in a position to improve patient care than ever before and in settings where it was not feasible before. To get the right dose of the right drug for the right patient at the right time, as is the stated goal of clinical pharmacology. The main challenge that I see is getting proper validated targets. In many cases we are precisely targeting a range that we hope results in better outcomes but the hard evidence is still missing. And as Roger Jelliffe put it so bluntly in Rotterdam, one target for all is as bad as one dose for all. We have to be better at finding the right target and then hitting it. For antibiotics, this will mean not just getting better info on the MIC (knowing it’s between 4 and 8 really does not help that much) but also learning more about tissue penetration. We have to keep reminding ourselves that we are not treating an infected Petri dish.

The content of the IATDMCT Blog does not necessarily have the endorsement of the Association.