… my mother said to me “you know, you’re not deciding what to study, you’re deciding what you’re going to do in life. And if you want to help people, then you should go for medicine.” I took her advice…
Igor Švab, Professor, Faculty of Medicine, specialist in general medicine. First Head of the Department of Family Medicine and current dean of the medical faculty, University of Ljubljana
Graduated from the Faculty of Medicine of the University of Ljubljana in 1981. Masters in 1988, PhD in 1991 at the University of Ljubljana. President of the European association of family physicians Wonca Europe 2004-2010. He is coordinator of national and international research projects and the World Bank projects in the field of family medicine. He published more than 100 scientific and professional articles in MEDLINE. Editor-in-chief of the journal Slovenian Journal of Public Health, editor of the European Journal of General Practice. Member of Slovenian and Croatian Academy of Medical Sciences, honorary member of the Royal College of general Practitioners (UK) and recipient of the title of Wonca World fellow.
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“Igor je naš suradnik, prijatelj, učitelj, motivator, vizionar…”
Igor is our collaborator, friend, teacher, motivator, visionary..
Through the ages….
Domhnall MacAuley: Let me take you back to the very beginning. Tell me about growing up, and when did you first have an interest in medicine?
Igor Švab: I always wanted to be an engineer like my father. But, at the end of secondary school, when considering university, I also thought of medicine but I thought that it would be too difficult and the study would be too hard. I remember that my mother said to me “you know, you’re not deciding what to study, you’re deciding what you’re going to do in life. And if you want to help people, then you should go for medicine.” I took her advice and luckily I was selected as one of the students. I was not one of the best ones, actually.
DMacA: You then went to medical school in Ljubljana. Tell us about that, because those were very different times.
IŠ: I entered medicine medical school in 1976 and, at that time, medical studies lasted for five years. General practice had been a formal specialist in Yugoslavia in 1962. General practitioners were known to do a lot of hard work but not of high quality. But, we had an opportunity to spend three weeks in primary care and I decided to have an adventure and go to a rural practice where I spent 24 hours a day with the local GP. And that changed my life. This was when I decided that this is what I want to do in life. After five years you were supposed to be fit to practice in general practice, which was quite a challenge.
DMacA: It was a very different political situation at that time, did that influence medical education?
IŠ: Not really. Medical science was left out of that. In Slovenia, former Yugoslavia, we were quite liberal so it was quite possible to travel abroad. As a medical student I had a chance to have my first international exchange, to Galway, Ireland, where I spent two weeks. Of course, there were some ideological subjects, like sociology and things like that, but that was not really an issue.
DMacA: General practice was very underdeveloped in Ireland at that time. So that must have been quite an interesting experience.
IŠ: My rotation was in internal medicine, so I didn’t have a chance to see general practice in Ireland at all. I do remember two things. First, the people in the pubs were very friendly and I was offered quite a lot of Guinness. And secondly, I bought a Claddagh Ring there, which I then gave to my girlfriend at that time. And it worked. We are still married after for more than 40 years.
“As a young person, I especially enjoyed emergency situations, running on home visits, saving people. And, you know, having a belief that I might have made a difference.”
DMacA: Let’s move on to when you finished medical school. What career direction did you take?
IŠ: After medical school I first had to go to military service for a year. And luckily those who had finished medical school went to practice medicine in the military, and this gave us an opportunity to practice practical skills. After that I immediately started working in a rural health centre, and I enjoyed that tremendously. As a young person, I especially enjoyed emergency situations, running on home visits, saving people. And, you know, having a belief that I might have made a difference. Later I became more interested in clinical practice and in practising correctly . I was quite popular as a rural GP and, at the age of 28, I became the director of a health centre, which was quite a challenge.
DMacA: By that time you had an interest in academia, and you did a masters. And that was an interesting topic.
IŠ: The ‘masters’ was a challenge because the idea had come from everyday practice. I had been wondering why certain people attended practice very often and others don’t come at all. So, I tried to find out what was behind the frequent attenders in general practice. The idea came to me from one of my patients who had come to the practice 51 times in a year. He came regularly every week and I wanted to find out what the reason was, so I asked him. I said, “you know, the year has 52 weeks. And you came to me 51 times. What was the one week when you didn’t attend?” And he said, “sorry, doctor. I couldn’t come because I was not feeling very well.” So that made me think about the reasons for attendance, how people behave, and so on. And, with this topic, I had quite a problem in the medical faculty because some of the committee members were not sure if this was proper science or not. But I had a very good mentor who was a professor of biostatistics and we convinced them that this was also science. And this is something that continued, in trying persuade academia that general practice, family medicine, can be a scientific discipline as well.
DMacA: Your PhD was very embedded in general practice as well. And it must have been a challenge to the academic folk to think about that topic also.
IŠ: The PhD was about referrals from general practice and that was at the time I was already involved in EGPRW which is now EGPRN, and Professor Douglas Fleming from the UK was asking for people that would be willing to coordinate this study in different countries. So myself and my colleague Milica Katić from Zagreb, decided to run this study one in Slovenia and one in Croatia. This was the basis of the PhD thesis and I had no real problem in defending it as scientific project.
“So, when I’m talking to my colleagues from other countries and they want to establish a Department of Family Medicine, and they ask can you give us some advice? I say, yes … There’s only one problem. And that problem is that this takes ten years.”
Teaching and Learning about Complexity. Bled Course 2025
Establishment of the Split initiative
Among many visiting Professorships
Award of Honorary Fellowship of the Royal College of General Practitioners.
DMacA: Tell us about the process of setting up the Department of Family Medicine.
IŠ: That’s a long story. In the 1980s in Slovenia, the general practitioners were very depressed, they felt they were neglected, and unloved. They were complaining a lot. At that time, a group of my predecessors said, “Let’s stop whining. This is not the correct approach. What we should do is to prove to others that we are as good as they are.
So we have to develop family medicine/ general practice, as an academic discipline. We have to have a department. We have to have our textbooks. We have to have our research. We have to do our own teaching.” So that was the basis of it all. What we did was that we started educating ourselves on teaching methods that would be appropriate for the discipline. We went to international courses that were then run in Dubrovnik in Croatia, where we met people from other countries; Denmark, Spain, UK, and so on. When we came back there had been a reform of medical studies with an extension from 5 to 6 years in all Yugoslavia. The university and the medical faculty had no idea what to do with this additional year so we came with a proposal. We said that we have the idea that we can introduce family medicine as a discipline, and that we could offer a lot of practicing physicians that would be willing to do this for free. This was an offer that no Dean could refuse. So we started talking to each other and at the time we also pursued academic careers because you can’t have a department unless you have teachers. In 1994 we managed to establish a Department of Family Medicine, and we continued on from there.
So, when I’m talking to my colleagues from other countries and they want to establish a Department of Family Medicine, and they ask can you give us some advice? I say, yes, of course it can be done- you have to fulfil all the criteria of the academia, you have to do research projects, and then you’ll be successful. There’s only one problem. And that problem is that this takes ten years. But it is foolproof. Sometimes they accept my advice, sometimes they don’t.
DMacA: You have been very involved in encouraging other people and other nations to develop general practice. Tell us about your international work.
IŠ: Coming from a small country of 2 million people, if you want to be successful in any discipline, you have to have international contacts. You don’t have enough critical mass of experts in the country. Even when I studied medicine, we learned from foreign books, from English and American textbooks, so that international context comes naturally. And, so I got involved very early in the international arena, going to meetings, not the major congresses themselves but mainly to working groups that were interested in research and education. In the 1990s, when Slovenia became an independent, I had the opportunity to represent Slovenia in many international organizations. The first was EGPRN was the first one, then
I joined EURACT and all the other organizations. That was very helpful and without that it would not be have been possible to be successful.
A link to the Slovenian Journal of Public Health
A link to the WONCA Europe Definition of General Practice
DMacA: You were involved in those two European organisations but then you became very involved in WONCA, tell us about your WONCA involvement.
IŠ: The turning point was the WONCA Europe Conference in 2003, in Ljubljana, which we organized. The conference was a big success with about 1600 people attending. The organization was very good and people were very enthusiastic. I was asked by Phillip Evans whether I would be willing to become President of WONCA Europe. I accepted and was President for two terms, which involved a lot of travel and contacts with people from all over Europe and the world. I learned a lot about how to negotiate, how to talk to people, what academic policies are, and so on. It was very important to me.
DMacA: You continued in the academic world and became editor of a Slovenian medical journal. Tell us about that.
IŠ: I became the editor of the rather obscure Journal of Public Health which was the house journal of the National Institute of Public Health. There were 10 or 12 issues every year but it had no real credibility. And when they asked me whether I would take it on as editor, I said that I would but only if they agreed on my editorial policy which would mean that we would reduce the number of issues per year and that we would apply strict selection criteria. We went from there and it took us ten years to achieve indexation. We got into Medline SCI. I’m no longer editor as I stepped down last year but now the journal has an impact factor 2.5 and I’m quite happy with the legacy.
DMacA: Another part of your legacy is that you were involved with many international colleagues in establishing the definition of general practice. Tell us about that work.
IŠ: The work on the definition general practice began while I was a member of EURACT and there was a group of brilliant people there, Justin Allen, Jan Heyrman, and others who decided that it was time to redefine general practice and describe what general practice is all about. We had a lot of very difficult and thoughtful discussions and, after several years, we, produced a definition of general practice https://www.woncaeurope.org/file/41f61fb9-47d5-4721-884e-603f4afa6588/WONCA_European_Definitions_2_v7.pdf that was then accepted by WONCA Europe and was the basis for many curricula of family medicine throughout Europe. It was very important to me to be part of this movement because I could clarify to myself what general practice really is all about in a way that I could also transfer to others, especially when talking to my colleagues in Southeast Europe and in other European countries. I could see that many of them were teaching a subject that is called “Family Medicine” but that doesn’t actually cover the specificities of this discipline. So, we went through revising the curricula and to me that work on the definition of general practice is very important.
A link to the Medical Faculty at the University of Ljubljana
” It’s a nightmare. You have to convince a bunch of academics to change their existing way of teaching, and they all think that they’re the best teachers in the world. It’s like moving the cemetery with the help of its inhabitants. “
A man of many interests, from gardening and cinema, to marathon running and alpine climbing…
DMacA: It’s a great tribute to your work, when you think back to where general practice started in Ljubljana, that you’re now the Dean of the faculty. That was a huge step.
IŠ: It was, in a way, a logical development because when we introduced the Department of Family Medicine at the medical faculty, we were the best subject in the medical school. Students loved us, it was an innovation in teaching. I was asked by the Dean at that time to reform the curriculum for the medical faculty. It’s a nightmare. You have to convince a bunch of academics to change their existing way of teaching, and they all think that they’re the best teachers in the world. It’s like moving the cemetery with the help of its inhabitants. It took us four years to make a change in the curriculum. And when the curriculum change was accepted, people saw that this was a better way of teaching, and when the term of the Dean ended, I was approached by many to become the Dean. At that point, I was the Vice Dean for Education because of the curriculum reform, so I was the Vice Dean running to become a Dean and luckily I got elected. Now I’m coming to the end of my second term so I’ve been Dean for practically eight years.
DMacA: My final question is rather unusual. As we reflect back, your career has always been high energy, always on the move, always doing things, but one of your interests is in slow cooking.
IŠ: I have many many hobbies. One of my hobbies, one of my interests, is good food. And I like to cook, and I like to take time for that. Another hobby is going to the mountains, mountaineering, and Slovenia is a paradise for that. So, I try to go at least every second week, to altitudes over 2000m. I also enjoy running and jogging which I do practically every second day or so. I also enjoy watching movies. Life is full of other beautiful things. Everything is not medicine. All this makes my life much easier and better because it gives a variety to your everyday routine. It’s not just thinking about academic family medicine but it also gives you ideas for other things.
DMacA: Igor, thank you very much for talking to us today and for taking us on a tour through your life, your academic work, and your great achievements and contribution to our discipline. Thank you very much indeed.
