If someone glances through modern insights into ancient medicine, the cardiology of ancient age would glare at him.
The word ‘hraday’, the “heart” encompasses two words namely ‘hru’, means to take away and ‘daya’ means to give; the organ that continuously takes and gives away (blood) is ‘hraday’ or heart.
Thus the cardiologist in ancient India was made much before William Harvey who in 16th century showed, that the heart is the seat of circulation, by demonstrating it in his Majesty's court, by taking a newborn child with ectopia cordis and is credited to be the ‘Father of Modern Cardiology’.
Today advances are taking place with such galloping strides in medicine, that specialty and super-specialty are inevitable. Today's cardiologist knows more and more of less and less.
Today's cardiologist may spend his lifetime working on chronic total occlusion or hypertrophic obstructive cardiomyopathy and may know little about anything else.
In today's day of burgeoning science, the student in cardiology is standing at an intersection of humanity and science.
It cannot be one of these, either humanity or science for a medical man since his job would require amalgamation of both.
Today's cardiologist is mystified by glorious images on magnetic resonance imaging (MRI) or angiographies and is engrossed on focusing on malfunctioning organs and is drifted away from doctor patient relationship. The fear, anxiety and agony of a fellow human being “a victim of cardiac illness” are such sentiments that should remind us that the patient is really impatient to get relieved from his sufferings and indisposition.
The makers of modern cardiologist, namely the teachers in cardiology will necessarily have to stress and emphasize on the lost art of the heart. Personal biases, greed and agendas should not be allowed to influence decision making.
Though it is true for many disciplines of medicine but perhaps more for a cardiologist, is decision making with lightning speed. In many critical situations once decision is made, it is irrevocable and the outcome could be either a disaster or elation. Courage, profound and robust common sense, help quick decision making, and that too backed by training and over and above all the mentioned ingredients make him confident.
Are these ingredients inborn, or are they acquired? Perhaps both.
In my forty years of teachership, I have several glaring examples of failures, where a cardiologist out of timidity would let the patient die of a life-threatening emergency rather than boldly stepping in due to the fear of adversity and being blamed of iatrogenicity, which in turn leads to scourge of ill-formed kith's and kin's of deceased and may culminate even in law suit.
A cardiologist should be trained to stay above ego. He needs to develop open mindedness, respectfulness to differing opinions of the peer group and to some brilliant suggestions from a colleague which could turn the table favorably in a critical scenario.
Who should be making a cardiologist? In other words, who should be a teacher in cardiology? A successful practitioner? A very well read professor, who is a walking 4encyclopedia but has poor ability to impart teaching? Again we have no system in place. In my student days, we would cluster around a versatile teacher who not necessarily was highly knowledgeable but knew what we would not be knowing and be able to be at the same platform as we were.
Teaching is an art and is essential for all those who are teachers. I am not aware whether in any profession; teachers are taught how to teach.
Moreover, when I think of my role as a teacher for more than forty years, I need to ask a question to myself, if I did my job well. The answer is no, a big “No”. Hundreds of cardiologists, practicing interventional or noninvasive cardiology all over the country and even abroad are fondly remembering me and my teaching (so do they say) but I strangely feel that an important aspect of teaching a science is to stimulate students towards imagination, innovation, originality and inquisitiveness.
It was Newton's inquisitiveness which led to the discovery of laws of gravity. Albert Einstein in 1929 in an interview to Saturday Evening Post, when a journalist asked him, “How do you account for your discoveries? Through intuitions or inspirations?” He replied both! I am enough of an artist to draw freely on my imaginations which I think are more important than knowledge. He explained that knowledge is limited to what we already know and understand, while imagination leads to all that ever will be to know and understand (Viereck 1929).
On December 11, 1956, in Nobel lecture Andre Cournand mentions that besides epochs of cellular and humoral pathology and many others, we can now perhaps speak on age of cardiological and circulatory investigations. We do this with comforting awareness, that by the correct application of their teaching, earlier discoveries remain useful to use, for they now appear in new light. Thus we guard ourselves against the mistakes which run all through the history of medicine. How true! Gone are the days of Galen, where teaching was observational and intuitional. Today we should teach our cardiologists to be able to challenge, to question and to oppose dogma.
India has yet to acquire a Nobel Prize in medicine. The only Indian to receive this distinction was Dr Khurana. He got this honor through his work at Wisconsin, USA and not in India. Surprisingly, he was even rejected for a job in India.
We as a teacher in cardiology, must have sixth sense to lookout for someone with hidden talent. How Sir Humphrey Devy discovered a peon at the bookshop and made him a Micheal Faraday. I am not going to talk about how much enormous efforts are put in, long working hours, many sleepless nights, stressful moments of accountability whist dealing with life threatening situations, since these factors are also a prerequisite in many specialties, say for example, an obstetrician, more erratic working hours and to his stake there are two lives simultaneously, i.e. mother and child to be born. What is more important is to ponder about questions we seldom think of. Who is qualified to be a cardiologist?
I do not know the clear answer to this question but I know that current system of making a cardiologist is too simple. Any individual who fulfills the basic requirements of university postgraduate degree in medicine is eligible to be a cardiologist.
One US Airways flight carrying 155 passengers had to make a forced and deliberate landing on Hudson river, in freezing October after engine failure. The captain had to make a crucial decision. He had to decide to take the crippled aircraft, which was likely to crash in air, to the closest airport or to the Hudson river. The decision had to be made in 30 seconds. He had a stake of 155 lives including one of his own. Everybody on board including children, were safely rescued. A lot of courage must have been involved in making this judgment. Cardiologist is also required to take such decision several times and that too more frequently than in other profession.
I feel equally important are the qualities of courage, quick judgment, compassion, empathy, as much as knowledge. In making a cardiologist, while assessing candidate aspiring of being one, there should be a system in place, which can evaluate those needed ingredients. I have seen many misfits during my career as a teacher for forty years.
I am not sure whether we have a system in place to guide anyone as to who should be a cardiologist. A cardiologist is more often than anyone who is required to take very quick decisions, exercise courage and competence and is required to face often hostile reactions from aggrieved family in situation where the outcome has been very unfavorable. Resultant morbidity, permanent disability or fatality in a given case, is often viewed as negligence and it needs a lot of patience to make the patient and family realize that the unfortunate outcome is often decided by uncontrollable factors and or due to human limitations.
What is also missing in today cardiologist, at large, is “compassion”. Unlike other disciplines of science, medical science also has to deal with human emotions. This should be dealt with delicately and with empathy.
In nutshell, making of a cardiologist deserves a very serious thought. We will have to make radical changes in our selection system and our examination system.
Once having found an appropriate material, a teacher's role is crucial and apart from knowledge, which is accumulation of existing information and its application, he should surely be vigilant to pick up such individual who has potential of innovation, since he could contribute to the progress of science.