News Report / Profile
The method and accuracy of Joaquim Ferreira
I met him on Open Day, the day the Faculty opens its doors to potential students, where he spoke of the act of freedom, which is to choose Medicine as a profession and introduced the challenge of looking at Vladimir Putin's posture when he walks. The arm dropped along Putin's body as he walks, and what lies behind this movement was the subject of a paper he published in BMJ (one of the most influential and renowned Medical publications in the world). A subject that is also spoken of in Stephen Colbert's Late Show.
Widely known for his work and for the numerous leadership positions he has held, it is almost redundant to say that he is an excellent speaker who likes to create interest in others, without ever presuming his listeners have assimilated what he has to tell. It could almost be the practical case of the Chinese proverb that says "Give a man a fish, and you feed him for a day. Teach a man how to fish, and you feed him for a lifetime." Disciplined even in his tone of voice and charismatic profile, it isn't hard to spot the obvious characteristics of a remarkable Professor who opens diverse leads for the vast world in which he works: Neurology.
He studied at the Faculty of Medicine, University of Lisbon, forbidding me to say with which Grade Point Average he enrolled. I venture at least to say that Joaquim Ferreira had the highest average ever.
His highly competitive spirit led him to pick Medicine. "Going to study something that wasn't the hardest was a waste for me." But it would be unfair to say that he is a doctor today just because it was a hard path: his aptitude is part of a vast number of characteristics of his personality. In his traits, of which he recognises, there was always a search for what demanded the most of him. This explanation is perhaps even more grounded when we know he was a competitive gymnast, from a young age. He started training at the age of 7. At 10, he already knew what strict rules were, as he trained 4 hours a day, 6 days a week. None of his days ended before 10PM. The first person responsible for the method, which was obviously intrinsic to him, was the gym teacher at the Physical Education Association in Torres Vedras, a German, who had left his country after World War II. The competition gave Joaquim Ferreira's muscles and brain discipline, while the rest surely came from family genetics. Genetics, which he does not rule out to explain so many characteristics of the human condition.
Having a pharmaceutical mother, he grew up in the middle of a clinical laboratory, despite some medical tradition in his early years. His disciplined and demanding family tells me that he was never forced to follow a certain path. However, he realises that mimicry is a characteristic of the youth when looking up to their role models.
He only abandoned the competition when he started college. The strictness of these behaviours has never left him, as there is still his sense of responsibility and commitment toward society, which does not allow him to fail.
He tries to pay attention to those who work with him, recognising the enormous privilege of having brilliant and generous mentors. Attempting to replicate the academic generosity from which he benefited is something he values.
Those who follow him know that he behaves in a very disciplinarian-like way towards his collaborators, but also with himself. In fact, a well-known Professor of German Neurology paid him this compliment: "Joaquim Ferreira is almost German."
"Going into Medicine means putting off a decision," he tells me. Logically speaking and with a scope beyond what seems to be obvious, he quietly releases small taunts to make us think, or to hold our attention. It is a captivating exercise of exchanging words and a way of being in life. It lets us think of things as he goes on into another matter, that is never just another matter. It is always equally important. Also not to be missed.
He was invited by Professor Castro Caldas to work with him in Neurology, after his 5th year in Medicine. The Professor asked him if he wanted to work in Neuropsychology, or in Parkinson's disease, the then student Joaquim chose the latter option because he understood that Parkinson's disease had a more "mechanical" and motor component. And because that decision would also tie him to his great scientific reference - Professor Cristina Sampaio. Still a student, he began to see patients who were included in clinical trials and it was Cristina Sampaio that bridged the gap between Neurology and Clinical Pharmacology, which led to the creation of a research field: Clinical Neuropharmacology. He started as a Neurology intern and finished his internship. All his work was primarily developed between the Laboratory and the Neurology service at Santa Maria Hospital, around Movement Disorders, which include Parkinson's disease.
With the departure of Cristina Sampaio to a North American Foundation, Joaquim Ferreira would naturally end up becoming Head of the Laboratory of Clinical Pharmacology in 2013; as for the scientific collaboration relationship between both, "it is present and very close."
As for the University Clinic of Neurology "there is a tradition of it being a space of excellence and freedom in which everyone has the possibility of developing their own projects" and goes on to say he is surrounded by great figures. “I have the privilege of being in a hospital service with remarkable tradition: Professors Miller Guerra, António Damásio, José Ferro, Alexandre Castro Caldas, Teresa Paiva, Mamede de Carvalho, very sharp people and with whom it is worth being in their presence, even when not discussing Neurology."
Chairman of the Pedagogical Council since 2017, he is in charge of maintaining the balance between teachers and students, ensuring that in the end the pedagogical merit always wins out. This is an organ within the Faculty with a great student participation, composed of six teachers and six students. Joaquim Ferreira has the profile of someone who knows how to break any divergence.
"It was not sought out, but they thought I could play this role and I regarded it as an interesting challenge in the natural sequence of previous responsibilities in the field of Medical Education in Neurology and I accepted it."
One of the immediate challenges involves implementing a new APP that aims to simplify and improve the evaluation of the teaching activity and to record student attendance. The goal is to improve the quality of teaching and to involve students more using a dynamic and agile system.
He thinks there is a logic that supports the succession of events in life, even though he has not explicitly sought out many of the responsibilities that he eventually took up. For several years he has taken up responsibilities in the field of education linked to the International Society of Movement Disorders. For over 10 years, he has coordinated education committees, both in the International Society and in the European section, which has allowed him to develop educational projects that have been recognised within these societies and can be replicated in Medical Education.
Demanding with his students and with what they may convey to patients, the same demand is not spared to his 6 children, who are so different from each other.
To be a good father, "one must find the right mother," an obvious success from a couple that met in college, where they were classmates.
Nothing is done individually and merit exists when you work together. However, there is a very silent responsibility that dictates very aligned rules every day.
Going into Medicine means putting off a decision? Help me understand...
Joaquim Ferreira: Being a doctor allows us to do a lot of things, including not seeing patients! I can be a neurologist, a cardiologist, a rheumatologist, a surgeon, or I can devote myself to fields of research or more technological areas that may be farther away from patients. It is, therefore, delaying a decision by opening up a range of options that allows us to choose. This postponement of decisions is a way of cultivating freedom, and this concept of freedom is one of the ideas that I try to pass on to those starting out in medicine. This applies to our options, to the field we choose to work in, and the institutions where we work. Not depending on a person, or a structure, is an act of enormous freedom. If I feel that what I am doing today is not motivating enough, and think that tomorrow I can move to Los Angeles, for example, it gives us freedom. Even if it isn't possible and you don't want to do it, having this perception of freedom brings me a lot of peace.
What we want at 20, don't we want it at 30, or even at 40 or 50? Do we change with the decades of our life?
Joaquim Ferreira: I think we really should change. We should change. First, because the world changes and what you're looking for at 20 isn't the same thing you explore in the following decades. And then, having goals per decade isn't a bad thing. When I turned 30, I was really upset with myself because there were a number of goals I hadn't accomplished. In the past, doctors would take their Doctorates later on, almost close to the end of their careers. Today that's supposed to happen during our internship. I often say it's a privilege to be a student and an intern! That's the phase in our life where we have more energy and creativity. Our skills change over time. Then there is the problem of monotony generating "disease." Recognising what gives us more satisfaction and exploring the field where we are most competent is a quality. (He pauses to think) The passing of time is cruel. Because, for now, it is irreversible, because it is associated with a set of inevitable medical problems and one must have the wisdom to adapt what we are to what we do. Clearly I worry about not doing likewise in a few years. I think this way even more at a time when I see our parents getting older and as we become the family patriarchs. This means from a personal, family, professional and biological perspective, we should try to change and adapt.
Off the record, you told me, genetics is a way of understanding the migration of populations. My question is, can genetics, one day, answer all the questions surrounding Parkinson and Alzheimers that we know so well?
Joaquim Ferreira: Portugal is an interesting country in that regard. Parkinson's disease isn't, as far as we know, genetic, that is, of hereditary transmission; however, about 5% of patients have genetic forms. One of the genetic causes is a mutation that is particularly frequent in Portugal and it is due to the fact that the Arabs were on the Iberian Peninsula. Therefore, particularly prevalent in Portugal and Spain more than in any other country in the Western world. So the answer is yes, although it is not the main cause of the disease. Alzheimer's disease is the same: if a patient asks me if the disease is transmissible, I say no, but there is always a small percentage of forms of the disease that are genetically transmitted. It's a very small percentage, but it does exist. They are families that, in general, have many family members affected and not just one or two people, as unfortunately happens in many families today. But going back to the beginning of the question, to have genetic transmission we have to consider that there are many cases, and they normally begin at younger ages than usual.
What got you interested in this mysterious field of understanding the human brain?
Joaquim Ferreira: People are the reason. At some point, we meet people who draw us into a certain field. But I can tell you that, if someone had seduced me into becoming a surgeon, it would never have workout because I am so obsessive that surgical times would be so long that no hospital administration would allow me to work. I suspect I'd get home and then go back to the operating room to see if everything was all right. (Laughs) Within the medical field, someone lured me and one day invited me to work in Neurology. That person was Professor Castro Caldas. On exam day, the Professor asked me to meet him at the Language Laboratory, where his office was located. Initially, I was curious about what we wanted, but what he wanted was to invite me to come work in Neurology. And I'm still here.
You're still here... We spoke about an interesting concept of freedom, where you explained that at any moment you could change whatever you wanted in your life and leave. But for now you're here because you want to. But this "here" is a Hospital that goes through the same strict, marginal budgeting we have seen in healthcare. Even so, are you free?
Joaquim Ferreira: Yes... I must say I have never stopped doing anything because of budget constraints. (He thinks for a bit) We must fight every day not to become the old men from the Muppets (Statler and Waldorf) that were always sitting in their box seats and spent their time complaining. Even because of our culture, there is a huge risk of us becoming professional complainers and I try to contradict that tendency. I'd rather say that I never stopped doing anything I wanted, even with restrictions. Now, of course, you have to make choices, and these require you to try doing something relevant and scientifically interesting, which is an increment in terms of knowledge, but looking for the niches where I can be competitive. I have to adapt, a little, my areas of interest to what I can be competitive in. When I don't do better, it's because I don't know how, because I can't or wasn't capable of it, and then I am the only one to blame. But this is a daily exercise. It easier to blame the system, now... Does our system makes us lose energy? Yes. Is it inefficient? Yes. Is it infuriating sometimes? Yes. Very much so, but we can only be angry for a few minutes and then we have to go looking for solutions. Especially when we are responsible for a growing group of employees. What today limits me more in my options are the people who rely on me, namely in training, in which my intervention is still instrumental. What really limits me is the responsibility toward the younger ones.
When we are very good students, is it because it's natural to us, or because we are really engaged?
Joaquim Ferreira: I remember when I went to college, my colleagues looked at me as someone who was a bit strange. (Laughs) We were a small class, the smallest ever, which Professor João Eurico was part of. We were only forty in 1986... Why does anybody have good grades? Because they have a huge work capacity and/or discipline. I was really studious, if that's what you're asking. (Laughs) Even before college, I spent a lot of time studying and was competing in sports, which required a lot of self-discipline and commitment.
Are we essentially an inheritance of our childhood?
Joaquim Ferreira: There are two things: part of it is biological, regardless of our upbringing; we are born that way, it's a priming, it's in our "proteins." And then there are other things that are modulated by education and experiences.
As a father of six, you have a reasonable sample that allows you to say that your children are different. Still, I imagine you have given the same references and rules to every one of them. Is personality innate?
Joaquim Ferreira: I have that conviction. I have twins, born ten minutes apart and they have completely different personalities. While one is adventurous and a sportsman, the other is more fearful and into cultural activities.
Can you explain, biologically, if we are born with a personality trait?
Joaquim Ferreira: The brain is an extremely powerful organ. I often joke that neurologists are special because they deal with a remarkable organ and come across very intriguing phenomena. I have patients with severe motor limitations who, during their sleep, become agile and stand up in an athletic way. That is, during their sleep, all their limitations disappear; when they dream that they are fighting with someone, they sit in bed and fight. I have other patients who cannot walk, and when they get on a bicycle, they pedal with no limitations. Have you seen the complexity of this organ? Hence my quest to draw younger folks to these fascinating matters. And I have a lot of young brilliant people working with me who are a lot better than me. And I don't want them to get lost in a path of difficulties, which is cruel sometimes. I don't want anything to stop them from growing and it's our country that loses out because many of them finish their degree and leave.
Do you try to hold them here?
Joaquim Ferreira: No. It makes me sad, I miss out, but I don't try holding them here. Because my next step is trying to build a bridge and help each other. I keep trying to open doors, even outside the country, and they keep helping younger doctors and that builds bridges.
Did that sense of a mission grow stronger at the Pedagogical Council?
Joaquim Ferreira: I'm the kind of teacher that "pranks" his students. If I have a class starting at 9am and students start walking in at 9:05am/9:10am, I'll say "good afternoon." Or if they come in later than that, I'll say "good evening." I find the lack of discipline in some of our daily behaviours unacceptable. This institution is heterogeneous like any major institution. However, it has something that not all other Institutions have. It has teachers, researchers, other great professionals.
The worst thing for someone with qualities is to go through a number of locations without ever coming across truly brilliant people. And I've actually been privileged over the years because I've come across fantastic, truly brilliant and generous people, and only then do we know what the top of the skill spectrum is. I look at this Campus of ours as a place with fabulous potential. It has a hospital with huge potential, a Faculty with a brilliant history, and a Biomedical Research Institute with growing scientific impact. These are the ideal characteristics for clinically training skilled health professionals, good educators with a sharp attitude.
What led Professor Castro Caldas to invite me was the fact that I disagreed with him during a practical class. At that time, and instead of having felt questioned, he thought that student who "provoked" him could, if at all, become a good collaborator. Then I met the most important person in my scientific education: Professor Cristina Sampaio, who was the Director of this Laboratory (Clinical Pharmacology) and which, as I mentioned, is in the U.S.; she is a remarkable person, one who I try to "copy" in the generous and critical attitude towards science and the Academy. I even think she would be upset if I did not have this behaviour. She is undoubtedly my main reference in terms of scientific thinking.
I know one of her concerns is students' assessments of Professors. Truth is, there are still few who collaborate and fill in the inquiries ...
Joaquim Ferreira: Students have a lot of power. They've gained it over the last few years and I'm not judging whether it's good or bad, it's a fact. But then, at times, I'm not sure they use that power for the most relevant causes. They waste time on details that they value and are not sufficiently participative in matters which are, in my opinion, much more relevant. Here I'll include teacher assessment.
Assessments are anonymous, right?
Joaquim Ferreira: They're anonymous.
Then why don't they do it? Laziness?
Joaquim Ferreira: I can't use that adjective. I think there's another reason. Students, like teachers, are a group with different interests. And, therefore, those we know best and that are more participative in Faculty activities may not be representative of the 2,500 students of this Institution. And there is a large group of students clearly less awake and motivated to respond to these requests.
But to be fair, I must say that I find such heterogeneity on the teachers side!
What is your main challenge as Chairman of the Pedagogical Council?
Joaquim Ferreira: Reminding all teachers that the main objective of this School is to train skilled doctors and that it is a privilege to be a teacher of this Institution. Even knowing that those doing basic research are highly focused on the scientific production of their laboratories... And professors of clinical areas have to fit the teaching activity into very demanding clinical activities.
This is just a reminder of our School's mission.
The second challenge involves creating conditions that will make the Medical Education field an area of research. I am convinced that doctors who do research or have training in scientific methodology are "better" physicians. Likewise, if we stimulate the research field in Medical Education, we will naturally contribute to improving the quality of teaching.
And lastly, I wish it were almost spontaneous to recognise our students in the future. Not by facial recognition, which would surely be nice, but by their attitude in the technical aspects of medical practice, in the way they communicate and in the sharp way of acting as professionals and people.
Is the division of 6 teachers for 6 students too equitable?
Joaquim Ferreira: (laughs) I think it is a huge privilege for students to be represented on the Council in equal numbers as teachers. But I am not sure students experience this reality the way I'm describing it... There are two elements that ennoble students' participation. One is the matter of the overall number of members and the second is the fact that they are peers, which means each of their votes is worth the same as the professors'. But they don't always assume their vote individually, rather as representatives of a group. They have a very collaborative attitude and that ends up taking away some of their individual potential. In reality, a student is like a teacher and that's something that I remind them of and ask them to remove the almost "trade-union-like" attitude of representing the students. It would be extremely important for them to assume themselves as individual members. I'm not always capable of it. They are very careful about expressing opinions without previously confirming with the group.
Do you get upset at them sometimes?
Joaquim Ferreira: Yes, it's happened...
And what comes out of those meetings?
Joaquim Ferreira: Overall, things usually work out very well. Because the students who are part of the Council are special students. It gives me great pleasure to work with them. Sometimes I get upset because there are small deviations on what we had agreed on, and having a solid relationship of trust is vital. They know that they have everything I can give them, but I expect the same availability from there, because there's a common goal.
What can be done to involve more students in Faculty activities, including professor assessments?
Joaquim Ferreira: When something persistently does not work well, we have to rethink the system. If, in the model that we implemented to evaluate teaching, the number of responses is low, we have to think about changing the format. It is natural that, in an institution over 100 years old, there are those who are less motivated, even to small changes. This year, we're going to have a system in which students record attendance and evaluate classes through an APP. At the end of each theoretical, theoretical-practical class, and seminars, they will answer two very simple questions. How do they assess the overall quality of the class and whether the class has achieved its objectives. The main objective of this measure is to, internally and in a constructive and positive environment, create warnings that progressively improve the quality of teaching.
Do teachers like being assessed?
Joaquim Ferreira: (Hesitates and thinks for a while) It depends. "It depends" is always the right answer because in all areas of knowledge there are always exceptions. (Laughs) Any new method of evaluation always raises some doubt, because there is an element of ignorance about what will happen and how we will be judged. And, very often, the reasons for evaluating may not have to do with the quality of the lesson! But I am sure it will be something that everyone will naturally understand and it will also be a great opportunity for self-assessment.
Going over everything for which you are responsible makes me wonder if the accumulation of functions and projects causes you to neglect something?
Joaquim Ferreira: We always run that risk. It's one of my morning troubles. In fact, I have two agonies. One is to be a "bluff;" that is, there is a discrepancy between what we stand for and what we actually are. That is, we do not deceive ourselves and others. The other anguish concerns time management. We are taught to be available and always respond positively. But time is not elastic and there are times when we begin to fail. At that moment, we have to make decisions and let go of activities that mean a lot. Then we have to have great collaborators and learn to delegate and trust.
Are you obsessed with perfection?
Joaquim Ferreira: I'm obsessed with detail and intolerant to not checking and to slouching.
But you know how to delegate. How does that fit together?
Joaquim Ferreira: (laughs) You have to speak to people that work with me. If they're honest in their answers, they'll say that I don't know how to delegate, or that I delegate enough. But ultimately, for the good and the bad, they have to hold me accountable.
Where does this apparently deep tranquillity come from? Is it real or is it a mask of self-discipline of those who are thinking of five hundred topics at the same time and can't stop assimilating them?
Joaquim Ferreira: (Laughs out loud) I'm glad that tranquillity is evident. Those who coordinate have to, at least, try to convey this tranquillity. You have the right to show some concern, but only for a few seconds ... Then you have to take responsibility, set a plan and resolve.
What are your biggest professional crises?
Joaquim Ferreira: It has a lot to do with budgeting, human resources, keeping commitments and ensuring the sustainability of projects. The biggest crises and worries are always matters involving others. I am concerned with the shortcomings that can affect the institutions I represent.
I still don't understand how you can fit so many professional projects and still have a great family project. You've already told me that you have to choose the right mother, but you have to be the right father, too, right?
Joaquim Ferreira: (There's a silence and a door squeaks slowly, it seems time has stopped) Kids aren't the problem. Those who have this life know that there are multiple requests, we travel often, we leave a lot. And it is interesting because, sometimes, I stop to think about what unites and motivates those who have this life. People who hold leadership positions in Universities, Scientific Societies or international research groups are all very much alike. They are what we call outliers, they are not representative, they are different. Why? Because they have a huge capacity for work, because they are those who say yes almost compulsively, those who are always available, those who meet commitments. And who misses out? Our family. It takes a fantastic partner to make it work.
Do you find fantastic partners by luck or is it hard work?
Joaquim Ferreira: It isn't luck; surely the choices we set as life goals have a lot to do with it. Of course it's good to meet interesting people, but the rest is not by accident.