Altissima quaeque flumina minimo sono labi. The deepest rivers flow with the least sound.
This classic idiom is brought to mind when you make the acquaintance of Dr Martin Šrámek, head of the comprehensive stroke center at the Central Military Hospital in Prague (KCC ÚVN).
The Angels booth at ESOC in Basel is buzzing in the hours following the ESO Angels Awards ceremony. Winners are striking poses in front of the awards wall and flinging their arms around colleagues not seen since the previous May.
Despite the tumult, Dr Šrámek’s voice remains even as he recounts the details of a career spanning two decades of momentous change in stroke care in the Czech Republic. But his understated manner conceals a subtle nature, and to fully comprehend the breadth of his achievements, you’d best ask someone else.
Angels consultant Martin Liptay is happy to oblige:
Prague’s Central Military Hospital won its first ESO Angels Award in 2017, barely a year after Dr Martin Šrámek took over as chief of KCC ÚVN and a year after the stroke quality registry RES-Q began enrolling its first hospitals.
Only 17 hospitals from eight countries qualified for the inaugural awards. In the same quarter in 2024, almost 300 hospitals around the world would receive recognition for providing quality treatment to stroke patients.
Now one of the world’s largest quality registries for stroke, RES-Q was conceived as a registry-based study to document stroke care quality and the ability of evidence-based care to remove disparities in stroke care. Dr Šrámek, together with RES-Q founder Robert Mikulík and Czech Stroke Society head Dr Aleš Tomek, was there from the beginning, collecting feedback from Czech users to optimize processes including the data collection form. As RES-Q spread into the world and became more complex he has continued to channel feedback from Czech doctors into the project.
“Martin is basically one of the main unknown co-authors of current RES-Q forms and structure,” says former Angels consultant (and now team leader) Robert Halvada who recalls joint trips to Brno in the early days of RES-Q to implement feedback from Czech hospitals. “His personality requires time to build a relationship, but once you earn his trust, you gain an irreplaceable leader who creates and implements solutions.”
Dr Šrámek’s leadership at KCC ÚVN has consistently delivered an award-winning performance, recently culminating in their second diamond award. In addition he is reponsible for checking and approving data reports generated in RES-Q before they are disseminated to all stroke-treating hospitals in the Czech Republic, and serves on the board of the Czech Stroke Society and its scientific board.
“I like things besides daily treatment,” he says. “I am also interested in organization.”
I chose the brain
When Martin Šrámek made up his mind in high school to go to university and become a doctor, he was choosing a way of life as much as a profession. He initially considered internal medicine, but moving across Prague from the University Hospital of Královské Vinohrady to the larger Bulovka Hospital in 1999 presented him with a choice between cardiology and neurology. The way he frames it, he let arrogance decide.
“You cannot see the brain,” he explains. “You have to discover a disease entirely based on clinical symptoms. Being able to see something made it seem too easy. I was arrogant, so I chose the brain.”
In 2001 he joined the Neurology Clinic at Motol University Hospital, one of the largest multi-disciplinary medical institutions in the Czech Republic and Europe, and one of the five medical faculties of Charles University in Prague. Until then, the outlook for patients with acute stroke had been grim. “They were treated with glucose and neuroprotective drugs that never worked,” Dr Šrámek recalls. But shortly after he arrived at Motol thrombolysis for ischaemic stroke was introduced in the Czech Republic, significantly improving outcomes for stroke patients and fundamentally changing the practice of neurology.
While at Motol Dr Šrámek embarked on the study of neurosonology – a diagnostic method using ultrasonic imaging to unravel the complexities of cerebrovascular diseases. At the same time he became a student of traditional Chinese medicine, in particular acupuncture, which was gaining ground as a treatment option for neurological conditions.
“I like Eastern culture,” Dr Šrámek explains. “I became interested in acupuncture because it offered some patients more possibilities for treatment. Western medicine is good for some cases, but others are better treated the Eastern way.”
Headache, facial nerve paralysis and alopecia are among the neurological conditions for which acupuncture may have better answers than Western medicine, he says.
“Western medicine is very effective but it isn’t good to be arrogant and only see things from a single perspective.”
A second life
Stroke care quality monitoring in the Czech Republic is mandatory, transparent and public. This creates a competitive environment where everyone can see how your data stacks up against your neighbours’ and, as Dr Šrámek puts it, “no-one wants to come last”. Peer pressure drives performance and is among the reasons why the average door-to-needle time in the Czech Republic has dropped from 60 to 20 minutes since RES-Q was launched.
It’s a different ballgame now from 2016. Initially modeled on an existing registry, RES-Q now provides comprehensive analyses, data visualisation and realtime stroke care quality dashboards to help stroke teams identify gaps and take targeted actions to improve their stroke care.
User feedback has been the key to keeping things simple on a platform of increasing complexity. Aside from refinements such as ruling out ambiguity and making it harder to make mistakes, it has been important to differentiate between optional and compulsory data in order to accommodate the perspectives, priorities and resource availability at both large university hospitals and smaller regional hospitals.
Dr Šrámek has the advantage of a regional perspective. Between leaving Motol University Hospital in 2011 (in the safe hands of his close friend Aleš Tomek) and returning to Prague in 2016 to take the reigns at KCC ÚVN, he worked in small centres in the Central Bohemian region – first as ICU chief and stroke centre coordinator at Kladno Regional Hospital and then as head of the neurology at Hořovice Hospital.
When he came back to Prague in 2016 his own life had changed. In fact, recently married to a neurologist he’d met in Kladno, he was embarking on “a second life”.
Already the father of teenagers aged 17 and 18, he is now raising a handful of little ones aged three, five and seven, and free time is family time.
While he enjoys rock climbing (and lists high-altitude medicine among his professional interests), a favourite activity is singing in the car with his wife and children when they’re driving somewhere, he says, summoning up a consummate image of contented family life.
Life is good
The river has another surprise to reveal, which is that Dr Šrámek is an accomplished jeweller who obtained his license after five years of study. Crafting jewellery out of silver and gold is a practical pastime: “You don’t need a big workshop, you can do it in one room, in one place.”
Practicality aside, he just likes to make things with his hands and give them away.
“Jewellery is something palpable you can give to your family and friends,” he says, drawing a comparison with the fleeting rewards of practicing medicine, such as the momentary satisfaction of having an article appear in a journal. “Or the patient goes home and a nice feeling in your heart is all you have left.”
“We are like hobbits,” he says in an attempt to describe the Czech national character. “We don’t move to other countries, we don’t become expats. We may travel and work elsewhere, but we always come back. Living in our country is easy. We’re not a low income country, healthcare is good and our lives are normal.”
It’s small country, densely populated with almost no remote areas, and the stroke community enjoys the support of the ministry of health which mandates data collection and reporting. But there’s another important reason why Czech hospitals have world-class door-to-needle times or why the majority of its stroke-treating hospitals (including every single one in Prague) have achieved diamond status.
A unified stroke community is central to their success, Dr Šrámek explains. “We have only one stroke society and that is very important. The unity of the professional society means we have one goal – to improve stroke care and not to fight other enemies.”
