Dr. G. Balčiūnienė: “I Am Often Asked Why There Is So Much Laughter in the Gynaecologist’s Consulting Room?”

“The genius is in simplicity. It seems to me that the goal of any scientific research is not to create a complex, difficult to explain method, but rather, on the contrary, to find the simplest way to bring as much clarity and accuracy as possible into clinical practice,” believes Dr. Greta Balčiūnienė, the obstetrician-gynaecologist and a junior researcher at Vilnius University. The doctor talked about her recently defended doctoral dissertation, which took four years to complete, and communication on Instagram.

At the beginning of April, you defended your doctoral dissertation titled “The importance of inflammatory markers in maternal blood and amniotic fluid for the diagnosis of chorioamnionitis”. Tell me about the problems you explored What is your dissertation about? How is this topic relevant to society?

Chorioamniotitis is an inflammation of the placenta, the membrane of the foetus, or in other words, an inflammatory process in the uterus. It is associated with 40-70% of premature births. If the waters break early, the doctor is in an “uncertain zone” having to decide whether it is necessary to induce labour or not. Is it necessary to take action quickly, and if so, how quickly? Is it better to postpone things, so that the baby can mature and be better prepared to come into this world?

The problem is that when there is infection in the uterus, the risk for a new-born to be born with a congenital infection increases. This often causes pneumonia, sepsis, a severe condition for a new-born, prolonged treatment in the resuscitation unit, and even a five-fold increase in the risk of death. So, in this situation, we are in unknown territory and must choose either to wait or take a risk. We might not be certain that there is infection and wait, or go head in order to avoid a serious condition for the new-born that waiting may cause.

My dissertation research was intended to help discover markers that would help doctors to make the right decision in these unclear situations. At present, we have criteria that we use in clinical practice, but they are not always accurate. For example, the criteria we use to assess if there is no inflammation, then we decide to continue the pregnancy and repeat the tests several times a week until the indicators show that the infection has started. Then we might induce labour and realise that we have waited too long for the baby to be born – the infection had started before our tests registered it. Such a new-born will be born with a congenital infection and will be in a serious condition.

You mentioned that in your dissertation you sought to find markers to make it easier to make a decision in a given situation. Did you manage to do this?

Yes, I did. I relied on many articles, and various studies performed abroad. This issue is relevant worldwide. It is worth noting that uniquely, in my research, we wanted to take samples of amniotic fluid that were required for the study, in a non-invasive way. In previous studies, amniocentesis was performed, an invasive method whereby a special needle is inserted into the uterus with the help of ultrasound and a sample of amniotic fluid is withdrawn for further examination. When the waters have already broken, this procedure is difficult, because of the small amount of fluid remaining, so the risk of damage to the placenta, umbilical loop or the foetus, is higher. So, my non-invasive method is much safer.

In my research we did not look for something completely unknown, or undiscovered. We rather relied on the research of other researchers looking for ways to facilitate diagnosis and to then make it safer. So I verified against those markers that were made using an invasive method and were recognised as informative but by applying a non-invasive method.

The successful defence of the dissertation ended an intensive four-year period. How do you remember it? Was it a time of joy and satisfaction or a period of worry and sleepless nights?

This four-year period was very interesting in terms of work, research and family life, with many and varied changes. During this time, our family grew, my two children were born. There was no need for academic leave, because the children just naturally appeared in my research path and we all completed doctoral studies “together”.

I entered the doctoral study programme in my fourth year of medical residency. Since it was the last year of my residency, I was very focused on my studies. I was very pleased with this, because I had more time to collect data, take examinations, get various permits, complete applications for scholarships, etc. Later, after my children were born, I slowed down a little, but it did not stop me.

I wouldn’t say it was a very hard time, with sleepless nights. That was not the case. I like to joke that I completed my dissertation by the sea while on a vacation in Turkey. We went with the family, my husband and his parents looked after the children, while I was writing the thesis every day. I managed to handle it very well, I didn’t get tired.

What are the things you are engaged in today? What does your day look like?

I imagined that after the completion of my PhD, there would be a lot more free time, but this did not happen. The available hours were immediately filled with other work. In September, together with my husband, we opened a private clinic. It is like our third child to whom we dedicate a lot of our hearts and our time. So I spend my days either with my family or in my newly opened clinic. I do have more time for the family though. My husband was very happy after I had defended my doctoral thesis. He said it was a bigger holiday for him than for me, because I spent evenings with the family, and not at my computer.

There are not many doctors who would intensively communicate on social networks and are 'followed' However, you seem to be heading in that direction. You only started using your Instagram account in November 2021, and half a year later, you have over 10,000 followers. Why did you decide to use this platform? What benefits did you see?

I am very close to my patients. At the reception of my clinic, I am asked why there is so much laughter in the gynaecologist’s consulting room.

I provide consultancy to about 15 to 20 women a day, and a third of them keep asking the same questions. Sometimes it seems to me that the answers to these questions are very elementary and understandable to everyone, however, they are often unclear to patients. So, I created my Instagram account, and started filling it little by little with information about diseases, physiological conditions, etc. I can see that women like it, they ask hundreds of questions every day, and I try to answer them as much as I can.

I think this kind of communication brings us closer together. Later, I even recognised women, who after an online consultation on the social network, then appear in my consulting room. It seems to me that the sharing of information is very important. In 80-90% of cases, the success of treatment is determined by how well a person/patient understands the disease, and how close their contact with the doctor is, i.e. if they are not afraid to tell everything to the doctor and don’t hide anything.

Once the doctor explains the diagnosis in detail, the patient can agree to carry out the recommended tests and adhere to the prescribed treatment, and so everything goes smoothly. Conversely, when the doctor fails to explain the situation in full, the success of the treatment could be at risk. The patient does not understand the essence of the treatment, does not really want to be treated, uses the medication without need, and does not want to repeat the tests. I want women to understand the problems they face, to make it clear to them what has happened and why, how the problem can be solved and also avoided in the future.

What would you say to those who treat medics communicating on the Internet with disdain, and in general consider social networks as a time-consuming space that gives no added value, is not worth getting involved with?

Social networks are just an additional space where important information can be shared with the general public in a language that can be understood. Knowledge has not hurt anyone, on the contrary, it has only brought more clarity.

My main message to doctors, is to evaluate the patients you are seeing. Today, people do their homework and read about doctors before their consultation. A lot of attention is paid to feedback, you can read comments, and evaluations of the doctors by other patients. So the patient comes knowing who they are going to see and this shows that the patient appreciates the doctor and believes in them, because the patient has chosen this doctor to solve the most important problem of life – a health issue.

It seems to me that respect for the person who has come for consultation and warm communication is very important. The doctor should not treat patients like machines, but as human beings. The patient appreciates you because they have come to you. So, appreciate your patients too, doctors!