Prof. Andrea Rossetti is the head of the Electroencephalography (EEG) and Epilepsy unit of the Neurological department of the University Hospital of Lausanne in Switzerland. He recently published a potentially controversial trial in JAMA Neurology that questions common ways of practising medicine. In our interview, he tells us about his career, his motivations, his recently published paper and his view on clinical research in Switzerland.
“Studying medicine is about learning how to do your work – exactly like a craftsman does”
“I already wanted to become a physician when I was around 10 years old,” Prof Rossetti says about his career choice. Even though this childhood dream changed to becoming a physicist near the end of high school, he went back to his initial dream shortly after. “I suddenly felt that physics and pure science would maybe be too dry for me.” After receiving his medical degree from the University of Berne in Switzerland in 1996, Prof. Rossetti continued as a resident in Lugano, Berne, and then at the Neurological department of the University of Lausanne. His specialisation in EEG and epilepsy happened by chance. “I was rotating, and did not choose it actively. Often in life, things happen by chance, but then you have to seize the chance.” He pursued his childhood dream, but always tried to combine his career as a physician with clinical science. He felt that being a physician was sometimes comparable to being a craftsman. “In the first year of studying medicine you learn a lot about science, but after that it becomes more learning by heart and learning how to do your work. That was quite a deception for me in the beginning, but now I am in the job since more than two decades, so I am used to that,” he jokingly remarks.
“There are many epilepsy treatments that work well in rats, but they do not work well in humans”
Prof. Rossetti believes that there is a substantial difference between clinical and basic science. “Clinical science is important for the patients, but if you go outside the hospital, it is regarded as the small sister of the ‘real’ science,” he says. He believes that basic science, which is invaluable for generating hypotheses and testing them, often lacks the connection with the clinical side of the question. As an example, he mentions models in basic epilepsy science, which often fail to reflect the patient situation. “Several experts in the field increasingly question the widespread use of rodents as models for epilepsy treatment.” He generally thinks that there is room for improvement regarding the collaboration between medical doctors and basic scientists. “There is a need for more incentive. Maybe this could start during medical school, where a more comprehensive approach of useful science could be taught.”
“Our recently published study is not a goal in itself, but it sets the frame for the next generation of studies to come”
To the question if he sees himself as a successful clinical scientist, Prof. Rossetti humbly answers, “This depends on how you measure success. I am happy if I can answer some questions.” An important clinical question he posed was partly answered in the landmark study published in July 2020.1 “The world, and mostly North America, is moving towards a “more is more” approach: it is widely believed that if you do more the patient automatically gets better. But no one could actually show until now, for instance, that continuous EEG is associated with a better outcome in critically ill patients with altered consciousness, compared with repeated short-lasting (routine) EEG measurements.” Prof. Rossetti and his team tested this hypothesis in a prospective, multicentre study and actually could not find a benefit with continuous measurements. “The two study arms were really even in terms of mortality at 6 months, which is a solid, non-debatable outcome.” He still does not exclude that there might be a subgroup of patients who could benefit from it. “I think the next generation of studies should identify the subgroup of patients that really deserves this type of resource-demanding monitoring.”
“Several people told us that what we are saying in our paper is rubbish. Politely, but also sometimes less politely”
His study is controversial, as it does not fit into the “more is more” approach, but is rather in line with the movement towards “smarter medicine”. “Our results and suggestions go against financial interest, and against the internal belief of many clinicians and scientists that doing more is better.” From Prof. Rossetti’s point of view, this type of thinking is very common, and it will be very hard to move away from it. “When we presented our paper to peers or journals, we felt that several colleagues and reviewers were disturbed by the posed question; at times the wording went beyond what is usual in a healthy, scientific debate.”
“There is a team spirit in Switzerland – but it is not the same as in the US”
Prof. Rossetti spent most of his career in Switzerland, which he thinks is a really good place to perform medicine and research. “There are many advantages,” he remarks. “In Switzerland, we are very gifted with a high quality of life and social security.” He adds that he is convinced that when living in a good environment, it is easier to perform well. However, he thinks that getting people to work together can sometimes be difficult. “I think if Switzerland would be more consequent in bringing the whole country together for big projects, we could really compete with the top centres of research. This is the small gap we have to fill.” In 2004, Prof. Rossetti moved to Boston for a research fellowship in clinical epileptology. “Even though the way of performing medicine is more or less the same, the American way of teaching is still quite different from Switzerland,” he remarks. He especially appreciated the levelled hierarchy in the American system and he particularly sees differences in the team spirit between the two countries. Having experienced private social events with peers in the US, Prof. Rossetti tried to integrate this form of socialising in his clinic in Switzerland but encountered administrative hurdles. “I tried to organize these kinds of events on a regular basis. They, however, argued that it was against the rules: I was supposed to organise only one event per year under strict conditions,” he says, noting the increasing lack of flexibility that hospital administration showed in the recent years, which, ultimately, plays against the well-being of a performing team.
“If you don’t teach, your professional life is limited and you will be forgotten”
In his time in the US, he also learned that positivity is extremely important when teaching. “I was trained in Switzerland with the approach that if you do something right, it is just correct. But if something was not done correctly, your teacher would share your mistake in front of everybody. This is not like that in the US: it will be really appreciated when you do something right.” Prof. Rossetti also believes that it is extremely important to share knowledge with younger people. “Teaching and mentoring experience is something that seems not as much rewarded in Europe as it is in the US.” He believes that clinicians who invested time in teaching and mentoring live on in the minds of people even long after they retire, while those who did not will be quickly forgotten. In conclusion, he thinks teaching is a crucial part of a physician’s career. And what type of student does he like to teach? “He or she should be curious, smart, and bring an ethical background,” he summarises.
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