Professor Erwin Offeciers is a renowned adult and paediatric otologist, living and working in Antwerp, Belgium. He has extensive experience in cochlear implantation and has also spearheaded the well described bony obliteration technique. He is to sit on the forthcoming International Consensus Committee to agree criteria for cochlear implantation. Suzanne Jervis caught up with him recently.
Professor Erwin Offeciers.
What lessons did you learn from chairing the 2005 consensus agreement that might influence this one?
The most important lesson I took from that experience was that there is a delicate balance between evidence based medicine (EBM) and experience based decision-making in daily practice. Progress in quality medical care requires both approaches. Experience based decision-making is often the spark that sets off new ways of thinking and acting, but EBM is needed to prove that these new ways are correct. In a consensus statement, the experts need to base their statements on evidence and, in that capacity, wear their EBM hat. Leading experience based practitioners can explore new therapeutic directions and possibilities. However, the value of those efforts should ultimately be scrutinised by EBM experts in well-conducted studies, before ending up in a consensus statement.
Which areas of the consensus do you feel are paramount to include?
Apart from clearly stating what experts do know, based on well-conducted studies, I believe that a consensus statement should also indicate those areas that are not yet fully understood or on which there is not yet sufficient sound evidence. As such, it can suggest research projects to the field.
Erwin Offeciers - ‘Grappa’ - with granddaughter, Renée, at the piano.
Clearly the implant companies have played a major role in the development of the technology. Do you see them having a role in the agreement?
It is clear that the cochlear implant (CI) industry has played a major role in the development of CI technology and in researching the possibilities and limits of the technology. A vast body of research work has been, and is being, sponsored by the industry. This has undoubtedly contributed not only to the quality of care in the CI field, but it has also created the possibility to explore new horizons. This results in new scientific knowledge. CI technology is a beautiful example of how technological innovation can precede and generate scientific knowledge. It is also a great example of how the scientific and business world can interact positively. However, a consensus statement should be made by independent experts, not connected to CI companies, in order to have credibility.
Looking back at your time in your surgical training, what quality did you admire most in your teachers?
Decency and kindness, without which all our human endeavours are empty. Decency is the most important quality: it is the bread in our society, while kindness is the butter. It is nice to have butter, but without bread we starve. Apart from being a great and innovative ear surgeon, my teacher, Jean Marquet, had both these qualities, and brought them into practice in his dealings with both his patients and collaborators.
When you take stock of your career, which parts have given you most pride, and why?
I prefer the term ‘satisfaction’ to the word ‘pride’, because it contains a connotation of mutuality, a sense of bi-directionality. Satisfaction is based on giving and getting back in return. The main sources of satisfaction are my patients, our ENT department and the young surgeons I taught. As an ear surgeon, I have been able to help many individuals by improving their quality of life. This gave existential meaning to my brief sojourn in this world.
I am indeed quite proud of the department I built up with the help of my colleagues and collaborators. It was, and is, a happy place to work in and I know that when I retire, things will continue in the same spirit. Having trained and guided many young otologists is a third source of satisfaction. In a few years, I will feel like an old gardener, who has planted many different trees and nurtured them into blooming and bearing fruit. I hope that then, from time to time, I can take a stroll through that garden, watch how the trees have grown tall and strong, admire the fruits, and smile.
Erwin Offeciers enjoying a cigar in Nagasaki. (Photo by Bruce Black, 2012)
Offeciers in his office, Antwerp.
If you had to continue managing patients in only one field within otology, which would it be?
Reconstructing damaged and dysfunctional middle ears. For me this remains the greatest surgical challenge. When faced with such ears, as a surgeon you‘re on your own. It is you, with all the experience and skills you can muster, who must do the job. It very much appeals to the craftsman I feel I am when doing this kind of work. At the end of a long and delicate procedure, one feels akin to the medieval miniaturist, who has put the last tiny bits of colour in exactly the right place, and smilingly sees that the result turned out exactly as he planned it: a thing of beauty.
Have you achieved a work-life balance and, if so, how did you do it?
That’s a difficult one. Seen from the outside, I think most observers would find my life quite unbalanced: but I don’t experience it that way. The emotional feeling of balance comes from the equilibrium between what you want to do with your life and what you are actually doing with it. This is different for everyone: each life gives its unique response to that question. The answer lies contained in how satisfied you are with the situation.
A black dot in a white immensity – Lech, 2015.
I know that most of your spare time is spent playing the piano and reading. Would you ever consider writing a novel?
Part of the art of living is to come to terms with the fact that one must make choices. Although I like reading good books, I think I have to accept the fact that my pen is the scalpel. I write my stories on living tissue. My books walk, speak and hear.
Do you think they have contributed to your surgical career?
My voracious appetite for books has opened many windows on the world. This has been important in helping me to think out of the box when addressing medical or scientific problems. Books have also allowed me to live the imagined lives that, in the real world, remained closed to me by the necessity of choosing. They certainly helped me to acquire knowledge about the human condition and, by extension, helped me to better understand my patients in all their presenting variety.
I like to play the piano. It is a great way to acquire fine motor control of both hands. For a microsurgeon, this is a real bonus. Making music cleanses the mind and heart from the sometimes bothersome and frustrating noise built up during the job, replacing it with moments of beauty and peace at the close of busy days.
Erwin Offeciers receiving the IFOS Gold Medal Award from IFOS President,
Chong Sun Kim, during the IFOS ENT World Congress in Seoul, 2013.
You are clearly very proud of your children and their achievements. What do they think of your career and achievements?
My children love me, and I love them back to pieces. They surely think I work too hard and too much, and they won’t live their life in the same way. But they know and accept that this is my life; that what I do makes a difference to many people, and they see that it makes me happy and fulfilled.
I have been blessed that my loved ones have accepted that my life doesn’t belong only to them. That acceptance is one of their greatest gifts to me.
When your counterparts of a similar age are retiring, what keeps you from doing the same?
Happiness. I like very much doing what I am doing, and as long as I have the mental and bodily faculties to continue my work, I will go on until the axe of regulatory puts an end to it.
What’s on your bucket list?
I don’t have a bucket list. It is an impossible and devious strategy. Life is full of surprises and opportunities. The best things happen to you when you don’t plan for them. If you stick to a ‘to do’ list, you will miss many things that eventually will give your life its unique quality.
Interviewed by Suzanne Jervis.