Future medicos

Updated on: Monday, December 07, 2009

It’s the dream of many parents to see their child as a doctor and now students can see why. As India’s population surges, there is a huge leap in the number of people afflicted with chronic and acute diseases and/or in need of emergency care. Health issues that come with longer life spans are also multiplying. No wonder that the qualified health professionals are in great demand.

The recently formed Global Alliances for Chronic Diseases, in its inaugural summit, declared that heart diseases, chronic respiratory conditions, cancer
, and diabetes are the four biggest killers leading to loss of life (388 million people), and loss of foregone national income (India, China and the UK are set to lose $558 billion, $237 billion, and $33 billion respectively) — all over the next 10 years.

Heart of the matter:

Cardiology and cardiac surgery

Heart ailments claim the maximum number of lives in India and across the world. In fact, according to a report by an international group, by 2010, 60% of heart disease patients will be from India. It doesn’t end here. Studies have proved that a genetic mutation affecting 4% of Indians — and 1% of people worldwide — is responsible for the creation of a protein that almost certainly guarantees heart ailments. Add to that the growing number of young professionals who love fast food and have little time for physical activity and you’ll begin to see why health experts believe we’re sitting on a time bomb.

Cardiologists and cardiac surgeons work to prevent, diagnose and treat heart disease. Cardiologists are physicians who use non-operative measures to treat heart disease. Sudhir Vaishnav, chief interventional cardiologist, Asian Heart Institute, elaborates, “Cardiology can be categorised into two broad subsets: invasive and non-invasive cardiology.”
He adds, “Non-invasive cardiology is suitable for those who prefer fixed working hours, because this field primarily deals with non-emergency, elective procedures like echo cardiograms, treadmill testing, 24-hour ambulatory holter monitoring for blood pressure recording and EECP.”

However, if you’re considering a career in invasive cardiology, be prepared for “extremely demanding work hours,” warns Vaishnav. He says, “Cardiologists work 12 to 14 hours per day, and it is not uncommon to attend to a patient in the middle of the night.” Invasive cardiology comprises methods like an angioplasty/angiography, which imply minimally invasive vascular intervention. Other cardio specialties include electrophysiology (electrical properties of biological cells in the heart), paediatric cardiology, and adult paediatric cardiology (adults who were treated for heart problems as children).

Not to be confused with cardiologists, cardiac surgeons are trained in a surgical specialty, and perform surgical procedures on the heart or its blood vessels in the case of heart transplants, or to treat congenital, valvular or ischemic heart disease. The life of a cardiac surgeon is even more demanding than that of a cardiologist, clocking between 16 to 18 hours. Ramakanta Panda, vice chairman and cardio vascular thoracic surgeon, Asian Heart Institute, says, “Unless an individual is completely committed, s/he shouldn’t get into cardiac surgery. It takes a minimum of eight to 10 years to become a surgeon. However, while the monetary gains may be better in other fields like ophthalmology and orthopaedics, this is one branch where satisfaction is immense. You are treating a dying patient, and five days later, he is leaving the hospital, on the road to recovery.”

After completion of the 5.5-year MBBS (inclusive of one-year compulsory internship), a student must decide whether to pursue an MD in internal medicine (to pursue cardiology later) or MS in general surgery (to pursue cardiac surgery later). Both these courses are of three years’ duration, and are followed by a DM in cardiology or an MCh in cardiac surgery, of three years respectively.

A bittersweet problem:

Diabetology

The World Health Organisation (WHO) has stated that more than 220 million people worldwide are afflicted with diabetes, with 50.8 million of these from India alone — the largest diabetic population in the world. With one diabetes-related death occurring every 10 seconds, this silent epidemic has now become a matter of serious concern for health professionals.

“Diabetology is a branch of internal medicine that can be pursued after a student completes his MBBS,” explains Anil Bhoraskar, diabetologist, Asian Heart Institute, and secretary of Scientific Section, Diabetic Association of India. Bhoraskar is also a postgraduate teacher for the two-year diploma programme in diabetology offered by the University of Mumbai. He adds, “The two-year residency programme is affiliated to medical colleges, and students can pursue it after appearing for an open entrance exam. The course covers all areas that aspiring diabetologists must be familiar with, as diabetes can lead to other complications, namely retinopathy, nephropathy, diabetic foot, cardio and neuro.”
Diabetologists also have a role to play in the counselling OPD, wherein they help patients to come to terms with a
chronic illness, and make the required lifestyle adjustments. Bhoraskar adds, “Diabetologists will provide dietary advice, personal/skin care advice, and even counsel patients to self-monitor their condition, and adjust dosage accordingly.”

Countering cancer:

Oncology

Cancer accounts for 13% of all deaths worldwide and there are 1.5 to two million cases of cancer in India at any given time. Oncologists deal with tumours or cancer, and must deal with the whole spectrum of services for cancer patients, ie diagnosis, treatment — surgical oncology, radiation oncology, chemotherapy, and finally, palliative care (terminal cases and post-treatment recovery). S K Srivastava, professor and head, radiation oncology at Tata Memorial Hospital, explains, “Oncology consists of treatment of patients in four different ways: surgical oncology involves a simple or complex procedure for removal of tumour, radiation oncology involves using radiation from the outside (teletherapy) or from close to the tumour (brachytherapy), medical oncology or chemotherapy employs chemicals that are injected or ingested, as well as biological therapy to intercept the pathway of tumour development.”

Other areas include onco-pathology (diagnosis using various markers), anaesthesia, biochemistry, radio diagnosis, and preventive oncology. Srivastava adds, “For surgical oncology, a student should have completed his MS in general surgery or in a specific surgical field, and then go on to pursue the MCh in surgical oncology, focusing on cancer treatment in the area of his MS. For radiation oncology, students will have to pursue an MD in radiotherapy, while medical oncologists must have an MD in medicine, and then a DM in medical oncology.”

Seeing straight:

Ophthalmology

The average urban Indian’s life has changed. We spend hours in front of our computer screen, or have excessive exposure to dust and pollution while travelling. But these aren’t the primary areas for ophthalmologists. As Ashwin Sainani, paediatric ophthalmologist, Dr L H Hiranandani Hospital, states, “The biggest growth in the ophthalmological field is possibly in cosmetic areas — laser correction surgery has become extremely commercialised, and is a very lucrative business. We are also witnessing an increasing number of diabetic pat

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