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Cardiologist’s heart beats for Cyprus

In a cardiologist who splits his time between London and Cyprus, THEO PANAYIDES finds a man who is impressive, intense and articulate. And who sees a lot of patients

Professor Dinos (Constantinos) Missouris has a touch of the royal ‘we’. It’s not overly apparent when he talks – I only notice when I play the tape back in order to transcribe it – but it’s definitely there, weaving in and out of his conversation. “The system does not welcome us, as well as it could’ve done – even though we love this island 100 per cent, we would die for it,” he says, speaking in the plural but actually speaking of himself. “They don’t approach us in a nice way… Even now, we find colleagues behave to us in a much more elegant and sensitive way in the UK than they do here.”

What does it mean, this no-doubt-unconscious affectation? Some might say it points to arrogance and vanity, but I’m not so sure. It’s true that Dinos has no false modesty about his many accomplishments – but I don’t think the way he talks is a sign of being big-headed, if only because he seems so aware of that danger. “In medicine, there is a problem,” he tells me bluntly, speaking extremely fast as he does throughout our hour together: “There is a confusion between arrogance and brilliance. And this is the thing that essentially needs to change. We are all doctors, we all make mistakes. We have to admit our mistakes”. If anything, his royal ‘we’ may be a sign of the opposite – the fact that he’s so empathetic (it’s perhaps his greatest gift in treating patients) that he unconsciously tries to foster a sense of unity and togetherness, even when it’s really just himself he’s talking about.

He is indeed a doctor, and a high-flying one – senior cardiologist at Frimley Health NHS Trust in Berkshire (its catchment area includes affluent places like Ascot and Windsor) with his own private practice in Harley Street and additionally, for the past two years, a visiting professor at the University of Cyprus medical school. His background includes five years as senior registrar at St. George’s Hospital in Tooting, an establishment so eminent that one of its consultants was the Queen’s own cardiologist (Dinos is now a consultant himself, meaning a specialist with many years’ training), plus three years doing cardiovascular research with Professor Graham MacGregor, a world expert on hypertension. Dinos isn’t shy about acknowledging the world-class people he’s worked with – and, for instance, recalls being helped along in his career by “a very famous professor called Brian Robinson, I was his prodigy student”.

To that rich CV we can now add Medoclinic in Nicosia: “I am opening my own practice as we speak,” he confirms – though in fact this is something of a transitional period, even without the additional wrinkle of Gesy, our national health system (which he plans to support as much as possible), due to launch in a couple of months. It’s not clear if his plan was ever to leave the UK altogether – he does a lot of research, which is easier in Britain – but, in any event, he still has a foot in both camps. “My heart beats for Cyprus. 100 per cent,” affirms Dinos earnestly. “But I always knew that there are problems.”

Right now he’s in Cyprus five days a week, with two days in Berkshire. He’ll teach Monday through Wednesday – he plans to transition more into academia as he grows older – then catch the flight to England, working flat-out Thursday and Friday; “I finish at about eight, and run to the airport”. Meanwhile his wife and daughter live here full-time, the family having relocated four years ago. “I’ve got quite a unique family,” he tells me proudly: “I’ve got a very intelligent wife – a child psychiatrist, the most talented physician on the island – and a talented young daughter”. His daughter, almost 17, is a cellist and pianist who wants to be a musician. “She was at the Royal Academy of Music, that sort of level”, so bringing her to Cyprus may potentially have been a mistake – “but I believe in destiny,” says Dinos, “and I think it’s going to work for her. My gut feeling says that it’s going to work for her”.

St George’s Hospital, Tooring

The adjectives he naturally uses to extol his family are perhaps significant: not ‘a beautiful wife and the sweetest young daughter’ (which presumably would also be true), but ‘intelligent’ and ‘talented’. There’s no doubt he’s impressive to talk to, intense and articulate, and there’s no doubt he values brains and achievement. He talks very fast, as already mentioned, sitting in a coffee shop on a Sunday afternoon, a balding 58-year-old with a somewhat mournful expression; he questions the barista on the tea selection, asking specifically for Cypriot teas – then, having sniffed the various options, orders a cappuccino with no further comment. My first impression is that he doesn’t suffer fools gladly – yet I also suspect that he doesn’t blow up at those who disappoint him, just accepts the slight and channels it into further achievement. You strike me as a person who doesn’t get depressed very easily, I venture at one point – but Dinos just chuckles: “No, no, I get depressed easily. My other half thinks I’m hopeless when it comes to emotions!”. He shrugs bravely: “But we have to be strong, to survive the suffering of the patients.”

To be honest, I don’t get very much on him as a person; maybe there isn’t very much, once you take medicine out of the equation. He likes to read, though not fiction – mostly “relevant”, i.e. medical books – and doesn’t have time to relax at the moment anyway; he never smokes, and very seldom drinks. He sleeps on the flight back and forth, being too exhausted to do much else. He wakes up at five (not just now; this was always his schedule), does an hour of research, clinical NHS work from eight till six, then private practice, home at 10, in bed by midnight. “I don’t have time to think about tiredness,” he tells me flatly. “I think we have a big drive. Because medicine gives you a lot of drive, in a way.”

Doesn’t he know, as a cardiologist, that too much work is bad for a person? “I know, but – some people are built to last, as it were. The stock is good, the genetics are very strong.” He himself is of fine village stock, born in Zodia to a teacher of metalwork who was also a farmer and landowner; he had “a fantastic childhood, growing up in the fields”, then came the invasion, a change in circumstances, and medical school in the UK financed by scholarships and working in restaurants. His heart “beats for Cyprus,” as he says – but which Cyprus? Maybe not the venal and corrupt 21st-century Cyprus, where (for instance) civil servants always get top marks when being evaluated, so no-one ever gets fired.

That example is relevant – because quality control, says Dinos, is primarily what’s missing in the medical profession here: “If a doctor makes a mistake, how does it appear? It cannot appear”. It’s entirely different in the UK, where all doctors get an annual appraisal and must also be “re-validated” by the General Medical Council every five years. The money is also very different: a consultant’s salary in London – in London! – ranges from £4-6,000 a month, he says (a junior doctor’s will be £2-3,000); a private physician here can make many times that in a single week. That’s a big stumbling block for Gesy – though Dinos seems convinced it’ll work, mostly on the reasoning that patients “will prefer to be seen by Gesy doctors” since they’re paying for it anyway, thus creating a virtuous circle that’ll force more and more doctors into the system.

Maybe; but only if Gesy is viewed as equivalent to going private – which isn’t guaranteed when GPs (“the core” of the service, the first port of call) are such an iffy proposition. In the UK, to be a General Practitioner you need three years of training, “six months in obstetrics and gynaecology, six months in paediatrics, six months in general surgery, six months in medicine, six months in psychiatry, and six months out in the community”; in Cyprus at the moment, due to a shortage of candidates, retired hospital doctors with no extra training are signing up as GPs, and being accepted. (They think they can do it, shrugs Dinos: “As I said before, there is something called arrogance, confused with brilliance: ‘I’m good enough. Why shouldn’t I?’”.) It’s entirely possible that these ageing medics will find themselves out of their depth, sending almost all patients to a specialist and clogging up the system – yet, as we know, the unions are resisting the solution of importing doctors from abroad.

Prof. Missouris sighs heavily, bristling with weary irritation. “I know I’m not going to be liked by my colleagues for saying all this,” he admits, but “we cannot have a group of doctors blocking the development of the national health system of Cyprus… To be honest, if I was the Minister of Health, I would have broken a few bones. A long time ago.

“I think we have the unions, which is the biggest cancer Cyprus has ever faced. There is no change – there can be no change – unless you break the unions. They are not interested about the patients, they are interested about their own small community, their few members, that pay them money to be there. So, unless we break the unions – and, if I was there, I would’ve broken them a long time ago…” He pauses, his expression more troubled than ever. “We cannot leave a bunch of people who are abusing situations to determine the destiny of the nation. We are becoming a laughing-stock of Europe.”

I know, I agree reassuringly. It’s what everyone’s saying.

“But I am saying it loudly! I say we need the political will, we need to break some bones of the unions. The political parties have done enough damage to Cyprus, now is the time [for them] to get out and let the system work. Because what are we going to give to the new generation? More politicians? More corruption?… I’m saying this because I don’t need them, in a way,” admits Dinos, then adds: “Even if I needed them, I wouldn’t care”.

Partly, I suppose, it’s because of his UK experience. I didn’t really know how the NHS works, and I’m stunned to discover just how marginalised private medicine is in Britain. Consultants, i.e. those at the top of the ladder, are allowed “a session or two” per week (a session is four hours) – but even that, even his own Harley Street practice, requires a referral from a GP; patients almost never come directly, bypassing the system. (It’s not illegal to do so, but insurance may not cover it and many private hospitals have regulations forbidding it.) “In the UK, private practice is done in a more elegant and discreet way,” chuckles Dinos. “Here, it’s done in a more vulgar way”. What’s more, UK hospitals are heavily regulated: ‘they’ know everything about Dr. Dinos, from what time he comes in to whether he washes his hands in between patients. “They’ve got people essentially delivering to the management, day in day out, what the doctor is doing.”

Spies, in other words?

“They’re not spies, I think this is called management. Because the doctors, if you leave them on their own, they will do a bad job. They have to be controlled.”

Anyone who’s worked in such a system all their life is bound to be more idealistic – or perhaps just more cowed – than a private doctor getting rich in Cyprus. But there’s also something more in Dinos Missouris: an emotional intensity, a fervour that might almost be a spiritual calling (or, who knows, an escape mechanism?). “I believe in philanthropy. I believe in the human soul,” he tells me. “When patients come to see me, I reach the soul very quickly” – meaning, again, that he empathises, feels their pain (which may often be psychological rather than cardiac pain) very quickly. “My clinics are usually very busy. I usually see twice the number of patients my colleagues see… I used to see three times more, but I’m getting a bit older these days and not as energetic!”. This profound connection means a lot to him, even more (it seems) than any remuneration he might get for it. He talks of doing “charity” during the last few years in Cyprus, meaning helping patients who’ve been badly treated, and also talks of wanting to provide “a high level of care… possibly even without money, at the end of the day”. His greatest satisfaction these days lies in academia, teaching students or seeing a line of young doctors queueing up outside his office, begging to help him with his research.

“We are essentially very fragile,” says this sad-eyed, high-achieving man, summing up the wisdom of a heart doctor who appears to have barely paused for breath in 35 years. “It’s a very fine balance. A man comes in, the next minute he’s dead, in his 30s or 40s – and you’re there on the receiving end, trying to save them. So life, essentially, is very fragile. And it makes us aware that we have to live every minute of it, we have to enjoy every minute of life”. His own life is packed, by design. “I may crash out when I’m 65 or whatever, but at the moment we have a number of years to essentially give it a good go, and create what we want to create,” says Dinos, lapsing back into royal ‘we’. “To leave a legacy, as it were.” He’s gone before I know it, cappuccino barely touched, shuffling off with surprising briskness as the afternoon turns to dusk.

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