In the third world....any ambitious cardiologist would "kill" to get a post at a training program in a decent hospital in the western world (esp. the US & Canada). In the oil-rich third world countries, on the other hand, some "powerful" cardiologists have managed to gather enough resources and pull extra strings to "build" their own cardiology training programs in their own countries, with the hope of gaining"recognition" of their western counterparts someday.
Having said that, despite of such a marvellous achievement, 3rd world consultants overlooked an important pre-requisite to making a competent & reliable cardiologist, which is: detoxifying their own trainees by dropping the bad habits of 3rd world cardiology.
I totally understand that some doctors will "jump the gun" and become extremely defensive before even hearing me out till the end. There's no doubt that third world doctors are as smart as their peers in the western world, but they have a few habits that are the cause of their lagging behind the west. In oil-rich countries, money is never an issue, i.e. buying a new MRI machine or building a a new clinic/ speciality center is as easy as signing the cheque book.
Yet there's an important missing component in the third world that is always overlooked: Man Power. Bottom line is that regardless of the fancy hospitals' architectural design, or how sophisticated/expensive your diagnostic "arsenal" is, your hospital would be worthless if your doctors were lazy, unmotivated, or flat out incompetent.
Yet there's an important missing component in the third world that is always overlooked: Man Power. Bottom line is that regardless of the fancy hospitals' architectural design, or how sophisticated/expensive your diagnostic "arsenal" is, your hospital would be worthless if your doctors were lazy, unmotivated, or flat out incompetent.
The following is a brief account on what you should do to become a third world cardiologist. You will know from my sarcastic (yet realistic) remarks what makes our practice inferior to "real" cardiology.
Clinical "bedside" cardiology
1. Passion is overrated.
That's the bottom line. As far as you're concerned: No Job, No Cheque. Waking up at 6:00 AM to go to work is meaningless. Going an extra mile, under any circumstances is non-sense. Because at the end, everybody gets the same salary. Sometimes even the lazier doctor gets all the bonuses and promotions!
1. Passion is overrated.
That's the bottom line. As far as you're concerned: No Job, No Cheque. Waking up at 6:00 AM to go to work is meaningless. Going an extra mile, under any circumstances is non-sense. Because at the end, everybody gets the same salary. Sometimes even the lazier doctor gets all the bonuses and promotions!
2. Blame the patient for being sick.
Because it's always the patients fault. Make sure you instill a sense of guilt while communicating with your patients, e.g. tell your patient that his MI was due to his lifelong history of heavy smoking & he should have seen it coming.
Because it's always the patients fault. Make sure you instill a sense of guilt while communicating with your patients, e.g. tell your patient that his MI was due to his lifelong history of heavy smoking & he should have seen it coming.
3. Professional clothing (dress code) is not important and does not count. Exception to this rule is in private practice, where the doctor would wear a tuxedo if he has to!
4. Always take shortcuts.
Elaborating and digging into detail during history taking, physical examination, or file review/data interpretation, is a waste of time.
Elaborating and digging into detail during history taking, physical examination, or file review/data interpretation, is a waste of time.
5. Quantity matters, quality does not.
That includes documentation, i.e. writing proper, concise, & comprehensive notes.
That includes documentation, i.e. writing proper, concise, & comprehensive notes.
6. The goal of "Sub-specializing" is to reduce your workload,
not to master a skill or improve the standard of care.
not to master a skill or improve the standard of care.
7. Theoretical knowledge has the priority over clinical experience.
That's why cardiologists who stay home and study always do much better than those real-time cardiologists who spend their time at the clinical service.
That's why cardiologists who stay home and study always do much better than those real-time cardiologists who spend their time at the clinical service.
8. History taking and physical examination are not important.
So don't waste your time in that area.
There's even no need to bring your own stethoscope with you on the job.
9. Use only one diagnostic tool, and rely only on one diagnostic sign to come up with a diagnosis. Once a diagnosis is made, do not try to think of alternative diagnoses. Life is easier if things were either in black or white. Grey is an irritating color anyway.
10. Never teach/train/tutor your juniors.
If they have questions or queries, tell them to "go home and read". Juniors are there for you to abuse them, not to teach them. Remember that your junior students today, might (& ultimately will) become your colleagues tomorrow. So make sure to delay this inevitable outcome as much as possible, and not teaching them is one of the techniques to hinder that process.
11. Any non-physician at work, is inferior to you.
This is how 3rd world mentality mainly operates: teamwork is not tolerated.
The workplace has to be dominated by an "alpha employee". In the healthcare business, it is the physician. Nurses, technologists, physiotherapists, pharmacists and ward clerks, are there to "serve" the physician, not the patient. Then we wonder why we're called a 3rd world!
12. Adult congenital heart disease is a pediatric speciality and must NOT be taken care of by adult cardiologists, even if the patient was 60 years old!
ECG interpretation
1. Leads I & AVL are redundant and have no significant diagnostic value and should be ignored.
2. Recording an ECG for a patient with chest pain and an underlying LBBB is not important.
So don't waste your time in that area.
There's even no need to bring your own stethoscope with you on the job.
9. Use only one diagnostic tool, and rely only on one diagnostic sign to come up with a diagnosis. Once a diagnosis is made, do not try to think of alternative diagnoses. Life is easier if things were either in black or white. Grey is an irritating color anyway.
10. Never teach/train/tutor your juniors.
If they have questions or queries, tell them to "go home and read". Juniors are there for you to abuse them, not to teach them. Remember that your junior students today, might (& ultimately will) become your colleagues tomorrow. So make sure to delay this inevitable outcome as much as possible, and not teaching them is one of the techniques to hinder that process.
11. Any non-physician at work, is inferior to you.
This is how 3rd world mentality mainly operates: teamwork is not tolerated.
The workplace has to be dominated by an "alpha employee". In the healthcare business, it is the physician. Nurses, technologists, physiotherapists, pharmacists and ward clerks, are there to "serve" the physician, not the patient. Then we wonder why we're called a 3rd world!
12. Adult congenital heart disease is a pediatric speciality and must NOT be taken care of by adult cardiologists, even if the patient was 60 years old!
ECG interpretation
1. Leads I & AVL are redundant and have no significant diagnostic value and should be ignored.
2. Recording an ECG for a patient with chest pain and an underlying LBBB is not important.
3. Determinig the axis is not important.
4. No need to differentiate Atrial Fibrillation from Atrial Flutter, because the management in both scenarios is the same.
5. Differentiating AVNRT from AVRT is a waste of time. Just say SVT and get it over with!
ECG is not an important diagnostic tool anyway, since patient might end up having a coronary angiography anyway, especially in private practice.
4. No need to differentiate Atrial Fibrillation from Atrial Flutter, because the management in both scenarios is the same.
5. Differentiating AVNRT from AVRT is a waste of time. Just say SVT and get it over with!
ECG is not an important diagnostic tool anyway, since patient might end up having a coronary angiography anyway, especially in private practice.
Echocardiography
1. There's no need to record an ECG during the echo study. Since timing of cardiac events is useless.
2. 2D imaging is what matters most.
3. Your echo views should be as limited as possible. You do not want to stumble on an incidental pathological finding just because you were overzealous in taking extra shots!
4. Your echo study should not take more than 15 minutes, and your echo report must not exceed 50 words.
5. In patients with decompensated heart failure, assessment of systolic function is what matters most, diastolic heart failure is an overrated phenomenon and is of no diagnostic/prognostic value at all.
Echocardiography is not a real speciality anyway, since any cardiologist, including an interventional cardiologist, can perform echocardiography efficiently.
3. Your echo views should be as limited as possible. You do not want to stumble on an incidental pathological finding just because you were overzealous in taking extra shots!
4. Your echo study should not take more than 15 minutes, and your echo report must not exceed 50 words.
5. In patients with decompensated heart failure, assessment of systolic function is what matters most, diastolic heart failure is an overrated phenomenon and is of no diagnostic/prognostic value at all.
Echocardiography is not a real speciality anyway, since any cardiologist, including an interventional cardiologist, can perform echocardiography efficiently.
Invasive cardiology
1. Now that is the best and most important subspecialty in Cardiology.
1. Now that is the best and most important subspecialty in Cardiology.
2. You only need to know basic coronary anatomy. Interventional cardiology only involves performing a coronary angiogram (injecting the coronary arteries), and a consequent PCI if needed. Knowing and understanding coronary physiology is a waste of time. It is pure "plumbing".
3. Other skills of the speciality (e.g. Invasive hemodynamics, FFR, CFR, IVUS, IABP..etc) are not important and there's no need to master them.
4. If you're an interventional cardiologist, you don't need to have a stethoscope because you don't have to auscultate.
5. Publicity is vital.
5. Publicity is vital.
People have to know you if you were interested in private practice.
To make a long story short: As long as third world cardiologists have the above belief system, they will NEVER be as competent as their peers in the western world.
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