What Is a Neurologist’s Mission? A Conversation with Professor Andrejs Millers, Recipient of the Order of the Three Stars

What does the Order of Three Stars mean to you?

I feel great satisfaction – it is satisfying that the four decades of work I have put in as a physician in Latvia have been appreciated, and equally satisfying to feel that my determined decision to become a physician and help people has been correct. I have had multiple offers from foreign clinics to move abroad and leave Latvia, but I always declined these offers. Working for my homeland and its citizens has been the most important task of my life. Never once during my career have I doubted this choice, and today I am happy for my achievements in a profession that I love and that gives me daily satisfaction. 

The highest state award was not granted to you for a specific research project, or successful operation, but rather for your entire medical career. Where did this path of success start?

I already clearly knew that I wanted to be a physician in the 10th grade at Riga Secondary School No.1. I never doubted this idea, or had any other potential scenarios worked out. I indirectly have my parents to thank for this. My mother was a physician and a senior lecturer at Riga Medical Institute (RMI) and was a role model for me in terms of her attitude towards work and her patients, which affected me greatly in childhood. I do, however, want to emphasise that my decision to become a physician was completely independent. For the purposes of improving my grades in chemistry, I decided to transfer to Riga Secondary School No.2, which specialised in chemistry. In order to get better acquainted with working in medicine, I also started working as a nursing assistant in the operation theatre at PSCUH. During my first years at RMI, I got acquainted with the job of a paramedic with emergency medical service. After graduating from RMI, there was a mandatroy distribution of personnel and I my first three years of work was at Limbaži Hospital, which was a very interesting experience. Afterwards, I moved to PSCUH, where I have now been working for 33 years.

What was the moment that you understood you wanted to specialise in neurology?

When I worked in Limbaži, I met a large number of different patients. Today it is very difficult to imagine that back then the only tools a neurologist had at their disposal was a reflex hammer and everything they had learned at RMI. There were no other diagnostic tools.

I frequently encountered patients with severe conditions and understood that this field was a complicated one and therefore very interesting. I saw that it would definitely develop in the future, because it was and would be in demand. These considerations determined my choice, and in 1986 I came to PSCUH where I specialised in neurology under Professor Bērziņš.

I have been the Head of the Neurology Clinic of PSCUH since 2005, and have lectured at the Department of Neurology at RSU since 2002. I have also been conducting research in my field and organising various educational projects for neurologists.

So many duties! Routine and fatigue can quickly cause burnout in any workplace. How do you avoid it?

For me, the key to avoiding burnout is variety! If a physician only works with treating patients directly, which can sometimes get very monotonous, then after a number of decades you might get into a rut that resembles burnout. Variety is power!

Being a senior lecturer at RSU training future physicians gives me positive emotions, because I see the students’ desire to become good specialists. For over thirteen years I have been organising summer schools for neurologists, and now we also have winter schools. We invite local and international specialists as guest lecturers to introduce students to various innovations and achievements in neurological science and other areas of medicine. Medicine requires a multidisciplinary approach and knowledge in just one area alone is insufficient. Working like this requires active organisational work from me, which takes time, but ensures variety and prevents boredom or burnout from sneaking in.

Being in good physical shape is also a important to preventing burnout and my hobbies serve that purpose. I have been doing sports since primary school and the first sports discipline that I chose was orienteering. It is an interesting coincidence that I received this award in Riga Castle, which is where my interest in orienteering began back when it was a Pioneers Palace.

Later I also picked up other sports like hiking. Imagine arriving at a snowy camp in Tian Shan, but finding you cannot get down, because there has been a snow slide! I have realised that it is in these difficult moments that you get to know people the best. Now I have replaced hiking with sailing, which also requires being in good shape and good teamwork skills. What I enjoy most, however, is to travel together with my family. They understand and always support me. This is the general outline of my anti-burnout recipe!

You were yourself a student once, but are now training young physicians. How have students changed over the decades?

If I think back on my study years, I can say that I was a conscientious student, since I knew that I wanted to be a good physician that patients turn to. I am happy that I have never been short of patients. When I studied at RMI we had lecturers who were experts in their field, and they were patriots. You could listen to them for hours without getting tired. RSU today also has strong lecturers, good study programmes and a management team with a progressive vision of development. The study process itself is much more modern and democratic. Contact with lecturers is not always that important anymore since students can also acquire knowledge in the e-environment and they sit for state exams anonymously. As a lecturer, I therefore find it difficult to evaluate how conscientious a student has been, like whether they have been attending lectures or not. Times are different and students themselves are now more responsible for the way in which they learn. If a student has acquired the required knowledge and skills and is able to use them with a patient, I am happy as a lecturer. To achieve results, students must be more independent since no one is guiding or forcing them. If you want to be a good physician – learn a lot and be diligent!

When I graduated from RMI, I was assigned to work at a regional hospital. This enabled me to test my knowledge and skills with patients – I treated children, performed surgical manipulations, sutured wounds. This was great experience for me. I therefore believe that if the state has invested in a student, the state is entitled to point out to them where their help is most needed after graduating. I believe that it isn’t right if a young physician studies at the expense of the state budget and then leaves for work abroad and pays taxes there.

How have patients changed over the course of your career?

Unfortunately, the prevalence of various brain diseases is on the rise. Research shows that in the next 20 years the number of various brain diseases in the EU will increase by 34%. We must be ready for that. If, for instance, the incidence of dementia increases, the state and society must be ready to know what to do.

To limit these developments to some degree more thought must be given to brain health on a daily basis. For instance, we emphasise cardiac health a lot, but we much less frequently speak about brain health. Life expectancy is increasing and new therapy methods appear, but this can, however, lead to situations where brain health cannot keep up with the condition of the other organs. Various organ transplantations are becoming a daily feature in a doctor’s job, but you cannot transplant brains. All of us must be aware of this and train our brain to improve plasticity – at least by learning a foreign language!

You have now received an Order of the Three Stars. What else do you wish to achieve in your career?

Talking about brain diseases there are many diagnoses today that are still incurable. A lot remains to be done to ensure that more and more patients are cured, and the greatest satisfaction is seeing a smiling former patient walking toward you in the street. I believe that happiness does not only lie in receiving, but rather in giving and serving!