• About Career and Personal Achievements
• Innovation and Technology
• Education and the Didactic Role
• Ward Administration and Challenges

An original enLife News interview, together with Prof. Dr. Marius Stănescu, Head of Orthopedics – Traumatology Department at the Dr. Carol Davila Central Military Emergency University Hospital, Bucharest.

About Career and Personal Achievements

Enlife News: Mr. Doctor Marius Stănescu, can you tell us about your professional path and what motivated you to choose the specialization in orthopedics and traumatology?

Conf. Dr. Marius Stănescu: I like to think that I chose this job, but every day I tend to think that the job chooses us. Being modeled by an „old-fashioned” grandfather teacher, according to three customs „calligraphy – study – discipline”, I think I got the profile of rigor intertwined with the openness to newness confirmed by the results. That’s what a surgeon in any specialty does. I attended high school courses, the mathematics-physics profile at one of the most prestigious colleges in Teleorman county, namely at the „Atanasescu” National College in Roșiori de Vede, and thanks to my mentors, a teaching staff of high intellectual standing, medicine was the first and my only option.

In the summer practice of the last year of college, I had the revelation of the option of orthopedic and trauma surgery when, in the specialty clinic of the Colentina Clinical Hospital, I had the chance of a mentor from an anthology in Romanian medicine, Prof. Univ. Dr. Andrei Firică, with whom I stayed for 13 years. Another 16 years of dedication, effort, training, satisfaction and professional trials followed in the Orthopedics and Traumatology Clinic of the Central Military Emergency University Hospital „Dr. Carol Davila”, a second home for the soul and becoming, then for professional and human fulfillment.

Innovation and Technology

Enlife News: How has modern technology influenced treatments for conditions such as gonarthrosis or coxarthrosis in the department you lead? Similarly, how is innovation in Trauma applied in the ward and how does it help patients?

Conf. Dr. Marius Stănescu: In both orthopedic and trauma surgery, we find a sustained comparison with the logarithmic technological evolution of computer science. Thus, in orthopedics, in the period 1970-1990, a series of researches took place whose solutions found applicability in the treatment of degenerative diseases. Subsequently, the development of biomaterials marked an upward curve in the performance of prosthetic implants (of the hip or knee), which led to sustainable functional results. In this context, the 2000s created the conditions for broadening the range of diagnoses addressed (such as bone tumor), transforming orthopedics into a reconstructive surgical branch with a deeply functional character. Both in orthopedics and in traumatology – another branch deeply marked by technological evolution and biomaterials – techniques, procedures and treatment protocols have been standardized, making our specialty a top beneficiary of technology and informatics, and our patients, main beneficiaries of the professional skills of knowledge and operative technique of orthopedic doctors and traumatologists.

„Major” joint endoprosthetic surgery, minimally invasive/arthroscopic surgery, reconstructive surgery of tumoral or non-tumoral bone defects, osteoarticular trauma surgery of osteosynthesis and sports medicine (of bone trauma and joint instabilities) are just a short list of the superspecializations that have become a necessity in the professional training of doctors in our specialty. In the last 20 years, we have witnessed the „atomization” of specialties, especially interventional ones. Let’s think about what „general surgery” includes, generically, but also in fact; today we count more and more superspecializations/branches of that general surgery: bariatric, hepato-biliary, oncological surgery (with subdivisions). There is a need for study, training, improvement by niche specialties in fields that demand specificity and surgical skills (doubled by technical equipment and sanitary materials/implants) until we excel, each in the activity to which we have dedicated ourselves.

Education and the Didactic Role

Enlife News: How do you see your teaching role in training new generations of doctors and what are the main skills you try to pass on to students and residents?

Conf. Dr. Marius Stănescu: It is the 2nd aspect of our work in which I have sufficient reasons for optimism. We all know what (generically) „the 7 years at home” means. We can also extrapolate this expression in education and professional training. In medicine, we can say that most of the residents come to us with „the 6 years of college”, some very well prepared and motivated; they are enthusiastic, sometimes too enthusiastic, very open to new things, sometimes too open, so they would try to burn stages, and they are attracted by the „profitable/practical” aspect of the specialty. Our role begins by channeling their energies and modulating their evolution to form the doctors who will become the specialists who will treat our generation. Therefore, the objectives of their training will combine a good knowledge of anatomy, diagnostic and treatment protocols, training of surgical gestures, mastery of operative techniques, anticipating and solving unforeseen moments with calmness, rigor and effectiveness (obtaining the best result in the shortest time).

Another watchword is prevention – and we are not talking about the prevention of the risks of infections, which, by the way, are not „hospital” [nosocoma (gr) = hospital], but are much more correctly called I.A.A.M. (infections associated with the medical act). As evidence, studies are increasingly well documented that prove that, in an overwhelming proportion, infections are produced by the germs present in the habitat and microbiome of the patient diagnosed with I.A.A.M.. This aspect of our permanent concerns, sterility during maneuvers and surgery and pre-prevention and post-operative microbial, viral or fungal contamination are as important as the acquisition of technical and theoretical professional skills in orthopedics and traumatology.

Ward Administration and Challenges

Enlife News: As head of the Department of Orthopedics and Traumatology, what are the biggest administrative challenges you have faced and how have you addressed them? Do the National Program budgets cover the department’s needs? What are the National Programs that finance you?

Conf. Dr. Marius Stănescu: As early as 2017, I agreed to a department management contract and not a department „head”. My activity combines (with some effort, admittedly) administration times with the most beautiful moments spent in the hospital, those dedicated to the patient, for therapeutic purposes. Certainly, it was not only heavenly providence that made this hospital meet all quality and performance standards, and that is why I consider myself a „cog” in a well-oiled mechanism. The challenges are either generally valid, such as the permanent need for staff, the training and performance criteria of new employees, the balance between the rights and duties of everyone in the team, or they are challenges stemming from the need to be able to ensure, as comprehensively as possible, compliance and applying – and now everyone involved, at all levels knows what I’m talking about – the A.N.M.C.S accreditation criteria.

Another determining branch of the department’s management includes the income and expenditure budget. A „hot potato” for anyone who wants to perform within the reasonable limits of the budget and with the achievement of the assumed performance indicators. We benefit from a T.C.P. stimulating for a more intense, more applied activity, by treating cases with an increased complexity index. This is also one of the substrates and opportunities for the development in the Orthopedics – Traumatology Department of S.U.U.M.C. of 4 National Health Programs (P. N. Endoprosthesis., P. N. Articular Instabilities, P. N. Tumor Reconstruction of defects), P. N. Transplant and a AP-Trauma (Priority Activities). About AP-Trauma, I dare to say that the funding complements the effort of the management team of the Central Military Hospital, which manages to support the support offered in the treatment of „trauma and polytrauma” patients.

Then I move on to the sensitive point of the underfunding of P.N. programs. E and P.N. Instab, P.N. Transplant and P.N. Tumoral (I named them with acronyms because the financing also comes more and more „abbreviated”). Keep in mind that the degenerative pathology (arthrosis of the hip, knee, shoulder), but also the traumatic one (post-traumatic joint instabilities, fractures of the hip, shoulder and radial head) require the application of surgical treatment that includes endoprosthetic and tendino-ligamentous implants .

Also, in the pathology of peri-implant mechanical or septic complications for surgical treatment, the use of reconstructive materials that are extremely demanding technically and financially is recommended. Consider the capabilities and achievements of recent years in the specific treatment of patients in the Department of Orthopedics – Traumatology of S.U.U.M.C., with a continuous increase in addressability, and that long waiting lists will result in the office of any orthopedist in our department, for endoprosthesis or osteoarticular reconstruction . These lists of „impotence” in the treatment of a coxarthrosis, until they take place in about 9-18 months, are in fact the result of financing according to an algorithm not adapted to time and capability, not adapted to the specific needs of a system in full development and recalibration process, what must to have the patient at the center of concerns, primarily.