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Interview: Distinction between cardiologist and cardiac surgeon is blurring fast — Dr Mukesh Goel

Dr Mukesh Goel is a senior consultant of cardio thoracic & vascular surgery at Indraprastha Apollo Hospitals, New Delhi. He has also served as chief cardiovascular surgeon at Asian Institute of Medical Sciences, Faridabad where he started the programme of minimally invasive techniques in cardiac surgery and repair of aortic dissection (aneurysm).

Dr Mukesh Goel
Dr Mukesh Goel

Dr Goel has performed more than 2,000 heart surgeries including bypass surgery (off & on pump), valve surgery (repair/replacement), aortic root surgery for aneurysm & dissection (Bentall’s operation), minimally invasive cardiac surgery for MVR, AVR, ASD closure and has developed minimally invasive CABG and surgical therapy for heart failure (LVAD, heart transplant).

In an exclusive interview with India Medical Times, Dr Mukesh Goel shares his experience and insights garnered over his medical journey.

Tell us about your studies and experiences being a cardiac and thoracic surgeon.

I completed my training in cardiac and thoracic surgery from Maulana Azad Medical College and G B Pant Hospital in 2001. After that, I got associated with Escorts Heart Institute in Delhi for another 10 years as a consultant. Then I moved to Indraprastha Apollo Hospitals as part of their team followed by joining Medanta – The Medicity. In 2011, I joined Asian Institute of Medical Sciences, Faridabad as head of department and chief cardiovascular surgeon. For the last nine months, I have been associated with Indraprastha Apollo Hospitals again as a senior consultant. I deal with adult heart surgery, which comprises operations like bypass surgery or aortic surgery. My expertise includes surgery for heart failure, which may comprise heart transplant or planting assist devices to the heart.

Why did you decide to specialise in cardiac and thoracic surgery?

Cardiac surgery is very dynamic. The whole idea of connecting the heart to a heart machine and that machine then takes over the functions of heart followed by stopping the heart, so that it can be operated and then seeing the heart again coming back to life with normal beats is quiet exciting and gives thrill, while helping the community and people. That’s why, I became passionate about heart surgery.

What’s your view on capping the price of stents? How do the indigenous stents compare with the imported ones?

As far as capping the price of stent is concerned, it is a very good idea. Hospitals seem to be acting as profiting when dealing with stents while the fact is hospitals are applying the stents at almost import price plus mark up of dealers and handling charges, which doubles up the price to patients or customers. That’s why the government is looking at capping the price of stents. According to me, the government should consider the import price and then add the 10 percent of the dealer’s profit and logistics’ fees on it to be charged to any patient.

As far as indigenous stents are concerned, I am not too comfortable about them for that’s very nascent technology. Stent is not only a piece of metal in the shape of spring. There are thousands of designs and alloys which are being used in making stents, planting of which should be well thought and well structured. The reason I trust imported stents is because they are backed by years of studies and clinical data, which is not available in indigenous stents.

In terms of medical techniques, how do you keep up with developments?

There are regular meetings conducted at national as well as international level on specialised themes. For example, if somebody is learning about heart failure, he/she can attend the meeting with the similar agenda. There are also regular workshops conducted by medical institutes to teach new techniques.

In 2015, I took a workshop on ‘International Surgical Aspect of Cardiopulmonary Transplant Course’ at Freeman Hospital in Newcastle. While in 2014, I attended a master class on total arterial bypass grafting at Oxford. Because I am in the corporate sector, I have to take care of my own professional development.

From your perspective, what is the biggest problem in healthcare today?

In India, the biggest challenge is the affordability of medical care. We think that medical care is expensive but the fact is India has been the cheapest medical care provider in the world. For example, a bypass surgery in the US costs $50,000 while in India it merely costs $3,000, while the technology in India is imported from the US only. If citizens of India can’t even afford the world’s cheapest medical care, that becomes a failing part of the government on public expenditure. Many countries around the world have public health insurance, which takes care of people’s medical expenses.

Second is the misconception that corporate hospitals are the costliest and government hospitals are cheaper. At government hospitals, a patient pays one-forth of the amount what we charge for big procedures in private hospitals. A patient might be paying Rs 75,000 for a bypass surgery in AIIMS but AIIMS will end up spending another Rs 3 lakh on that patient with the help of public money. Hence, per patient expenditure is less in corporate hospitals as compared to public hospitals.

I suggest the government should issue some kind of public health insurance so that many people can avail health facilities. It should be in the government’s agenda and policy.

What new advances in the cardiac surgery field do we have now in India?

Earlier, when a patient used to suffer heart failure, he or she had no option in India except taking medicines and waiting for the end to come. Now, the heart transplant is picking up in the country.

For people who can’t really undergo heart transplant or not able to get a transplant organ in time, we have got assist devices available in India. This device can be fitted in the patient’s heart and support it’s functions. It is very reliable as people who were supported with this device 10 years back in the US and Europe are still doing very well with this device in their heart.

Now, aortic surgeries can be done from groin instead of cutting open the heart.

Where do you see cardiac and thoracic surgery in 5 to 10 years?

Traditionally, the distinction between cardiologist and cardiac surgeon is blurring quiet fast. Procedures now require combination of both the expert techniques. These days, if a patient needs to go through metal valve replacement, he comes in the morning and by afternoon he is out of the operation theatre fully awake and next morning he returns home and within three days, he can return to work.

What is the most rewarding aspect of your job?

I feel satisfied when I see patients going back home in 5-6 days really well as if they had no disease at all. These are the patients who come to me in serious conditions, who otherwise have no hopes of surviving. This works for me as motivation and keeps me going.

What breakthrough would you most like to make?

There is a lot of work being done nowadays, one of them includes genetically modifying animal organs and place them in humans. This experiment has been done by one of the universities in Israel. They have implanted organ of a monkey in another species, and it stays alive for more than two months.

Why this research and study is important for us because every year more than a lakh patients in India require heart transplant but hardly half of them get a chance of getting it done. There is a huge gap. If animal derived organs could be available for human use, that will be most exciting. We are looking at this development may be 10 years down the line.

Do you have any advice for medical students interested in pursuing cardiac and thoracic surgery as a career?

Cardiac surgery is not an easy branch to get trained in and most importantly to settle in. Opt for it only if you are passionate about cardiac surgery and can afford to stretch long working hours. Even after completing your training, it takes another 5-6 years at least to get to start as a consultant surgeon on your own. About 25% people get opportunity to practise good cardiac surgery out of all 100 people who get the training. Only those who are passionate about it can survive for longer.

by Priyanka V Gupta

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