‘Encourage Prevention Centres Rather Than Hospitals’
“My dream is to be able to serve the needy till I die,” says Dr Chris Vijay, President of the Cardio Renal Society of America, in an interview with Future Medicine. Here, Dr Vijay talks about his academic and professional life, and evaluates current cardiology practices in India and America. He chaired the cardiovascular track for the Global Health Summit 2013
By Sumithra Sathyan
Let’s start with your academic background. How is your journey so far as a doctor?
My journey as a doctor is interesting. I was lucky to have diverse experience, both culturally and medically. From St Xavier’s College in Mumbai to KMC in Manipal and Mangalore to the postgraduate training in Mumbai and Delhi, I was exposed to different languages and had some amazing colleagues. I did postgraduate training in Oxford region in Kettering, then diabetes and endocrinology training in Southampton . The Master’s degree provided a chance to get into the Cardiology Fellowship Programme in Arizona where I had an exceptional experience that led to my first job as a cardiologist and the director of Heart Failure Programme at Arizona Heart Institute. I learned a lot while on the job at AHI and was asked to step up as the director of research.
What’s been the most important change since you joined the medical profession?
Advancement in technology has been a major change. It is good and bad in many ways. Certainly, it has allowed us to diagnose better, faster and more efficiently. At the same time, these diagnostics come with a big price tag. Is spite of the technological advances, we have not seen significant change in mortality. If anything, the prevalence of chronic diseases is only growing and it looks as if by 2030, a quarter of the population of the world will be more than 65 years of age and will suffer many chronic ailments.
Are you happy with the quality of doctors coming out of the medical colleges in India and the role played by the MCI?
I was appalled by a recent article published in the Health Affairs journal. This article reports on the quality of care delivered by private and public providers of primary healthcare services in rural and urban India. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. There appears to be an urgent need to measure the quality of healthcare services systematically and to improve the quality of medical education among other policy changes.
What measures should be taken by the government to bridge the gap between the demand and supply of cardiologists?
The healthcare workers can be trained to obtain a certification in cardiodiabetes or noncommunicable disease prevention.
Primordial and primary prevention is urgently needed both in rural and urban setting.
A low cost insurance plan should be implemented to facilitate patients to seek attention for risk assessment even when they have no symptoms.
How do you evaluate practice of cardiology in India and America?
In many parts of the US, the winds are indeed headed for practices merging with hospitals. An enfeebled economy, combined with declining insurance reimbursements and rising costs, is still driving more cardiologists to engage in conversation with hospitals discussing integration.
Insurance coverage for smoking cessation/counseling is being addressed in legislature in the US. I hope this will happen in India as well.
In the US, cardiovascular quality programmes are active, including H2H (Hospital to Home in Heart Failure) and D2B (Door to Balloon Time for acute heart attacks.
What are the major issues of a healthy society in India?
The major challenge for the governments in low income countries such as India is to develop cost-effective strategies to respond to the threat from cardiovascular disease and its risk factors such as hypertension, diabetes, abdominal obesity, smoking, lack of physical exercise and high cholesterol.
The medical curricula need to be extensively revised to incorporate these diseases into the main stream.
Your dream and message to society?
Last week, we were in Ladakh on a medical mission helping the needy Tibetan refugees. It brought so much of spiritual happiness that is indescribable. My dream is to be able to serve the needy till I die. I do believe that we can surmount the progression of atherosclerosis and prevent diabetes, heart attacks and strokes. Being nice, being constructive in the problem solving mode and not in problem dwelling mode, being value driven and tolerant and develop a personal sense of righteousness or dharma while serving others at all times would be my message to society that will bring individual peace and social harmony.
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