Opinion

What it means to be a Cardiologist in India today?

Dr Harminder Singh, Senior Consultant, Cardiology, Mumbai

The image of a doctor has undergone transformation in the eyes of the patients and doctors themselves in last one decade. Therefore what it means to be a cardiologist is a very relevant question. Our generation has witnessed this change very well and we have participated in it. I have been practising doctor for 34 years and Cardiologist for 18 years, long enough to see 3 generations of doctors- our teachers, ourselves and our students. The change is visible and palpable.

Why Choose Cardiology?

There were many reasons to choose Cardiology. There is a wide gap between the capability of an MD and a cardiologist. Cardiology is a hands on speciality with so much skilful work to do which also gives the thrill of rescuing a patient out of high mortality situations on day-to-day basis. It also was the highest paying branch with glamour attached to it. Before joining AIIMS as student, I worked briefly as observer at AIIMS and Escorts Heart Institute. Stalwarts like Prof SC Manchanda, Prof KK Talwar, Prof VK Bahl and Dr Ashok Seth were my role models. I saw their knowledge, mannerism, attitude and skills which made me decide that it‘s going to be Cardiology only. It used to be and still is very tough to get into cardiology at an institutes of repute. There were less than 200 seats in the 90’s (now there are 334 DM cardiology seats) and additional 133 DNB seats at large number of private institutes have made it relatively easy of late. As a result cardiologists are being produced in much larger numbers as compared to other super-specialities.

Advancements in the field

Practice of cardiology has witnessed a sea change. In olden days we used to be more conservative and utilised lots of clinical acumen based treatments with only ECG, X-Ray and echocardiography at most hospitals. Our professors taught us lot of bedside cardiology. For example common emergency like heart attack was treated with simple blood thinners and beta blockers and nitrates. We used to insist on prolonged bedrest and gradual mobilisation. The mortality from heart attack used to be higher. But in the last 2 decades primary angioplasty has become available widely and emergency treatment of heart attack is done within first few hours and patient is ambulated the next day, if stable.  This has significantly reduced the death rate. In the last decade cardiology has also become technology based speciality with less emphasis on clinical bedside assessment. Newer generation echocardiography, CT scan, cardiac MRI, PET scan, state of the art cath-labs, cardiac biomarkers, event recorders and electrophysiological studies are now routinely available even in tier two cities. These investigations hardly leave anything to imagination and provide precise disease staging and quantification. This has led to precise evidence based algorithms and guidelines. This has made cardiology an evidence based speciality. Millions of dollars have been spent on conducting randomised trials to answer many clinical questions which arise in the minds of the clinicians. This has established many new treatments and while dumped many others.

Better Outcomes

Capabilities of the cardiologist has also grown leaps and bound. Availability of state of the art hardware and instruments have made treatment very effective, easier, durable and cost effective. For example newer generation stents, devices to close holes in the heart, EP studies, new generation pacemakers and defibrillators, and valve replacement without surgery are treatments which were not available 2 decades back. Valve replacement of Aortic, mitral and Pulmonary valves without surgery was unthinkable 5 years back but they have become a reality in our country as well. Similarly on the surgical side development of off pump surgery, very safe and durable Bio-prosthetic valves, safe pediatric cardiac surgery for complex congenital heart diseases (Blue babies) has transformed the outlook of these sick patients. These treatments have transformed cardiology into powerful and most rapidly growing branch of medicine. It is a great feeling and thrill working in the current era with all these advancements at our disposal.

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