The Opening Ceremony Of The 6th Asian Interventional Cardiovascular Therapeutics Congress

02 Jul 2010

By Professor K Satku

Venue: Sands Expo And Convention Centre, Marina Bay Sands

1 Good morning. Let me begin by extending a warm welcome to all and a special welcome to our overseas delegates and speakers.

2 I note that Singapore is hosting the Asian Interventional Cardiovascular Therapeutics (AICT) Congress for the second time since its inception in 2005. We are pleased to able to contribute to the development and growth of the AICT Congress.

3 Cardiovascular diseases including coronary heart disease are leading causes of morbidity and mortality not just in developed countries, but developing countries too, and are responsible for more than 7 million deaths annually worldwide. Singapore has not been spared this phenomenon.

4 Coronary heart diseases are the third leading cause of hospitalisations and the second leading cause of death in Singapore, comprising 20% of all deaths locally.

5 As the medical community acts to treat cardiovascular diseases effectively, interventional cardiovascular therapeutics has emerged as a leading modality of treatment.

6 Interventional cardiology has a long history in Singapore. Percutaneous Coronary Intervention services began in the early 1980s and have been increasingly employed for the investigation and treatment of coronary heart disease.

7 The specialists managing these cases had undergone long periods of training starting with internal medicine, then cardiology and finally subspecialising in interventional cardiology.

8 Many of our pioneer cardiologists had to train abroad as the teaching and experience needed was not available here. We are fortunate that today we have significant expertise in interventional therapeutics and we are able to train our next generation of interventionists locally.

9 While we continue to train our interventional cardiologists in very much the same way, beginning with internal medicine and cardiology and only then subspecialising in interventional cardiology, there is a clear trend towards earlier subspecialisation.

10 Last year we announced our plans for enhancements to the local post-graduate training system which would result in a transition from the British apprentice type system to the more structured US styled system.

11 Many of my colleagues were concerned that this may drive earlier specialisation and subspecialisation.

12 Let me emphasise that the enhancements were made to keep Singapore’s postgraduate medical education efficient and not to drive subspecialisation.

13 In fact, there are already many forces at play globally which have been shaping the development of subspecialised fields of medicine. There is a trend to provide specialised services cost-efficiently and for institutions to value efficiency and cost containment over professionalism and holistic care.

14 Further, do patients value the technical expertise of a doctor in a specific area more than his ability to provide holistic care?

15 There is no single answer. Patients’ needs and societal expectations are neither unified nor homogeneous. There are those who prefer holistic care, expecting their doctors to take into account the various facets of their health and well-being, while some view health interventions as single impersonal transactions.

16 These preferences may also vary depending on the type of intervention and nature of condition being treated.

17 To address such diversity, we need to nurture doctors who are equipped with a depth of expertise in specialty medicine but who at the same time retain the breadth needed to provide intelligent well-rounded care.

18 We all know that the advantages of subspecialisation are increased expertise and enhanced proficiency in skill. With increasing specialisation, however, there are dangers for both the doctor and the patient.

19 The doctor risks losing aspects of practice that actually define the medical profession while the patient risks fragmented care and management, that is less than comprehensive.

20 When specialised fields lose the holistic nature of medicine and become a technical exercise, well trained physician extenders may begin to supplant doctors to provide the service.

21 There are several examples which have already occurred in other parts of the world to show that this is not a fantasy.

22 Although regulations today restrict such practices to doctors, the role of regulators is to continue to liberalise healthcare delivery wherever possible, while ensuring that the provision of healthcare is safe.

23 So if such developments are in the best interest of patents they are likely to take place. Thus, perhaps contrary to expectations subspecialisation may allow the boundaries of medical practice to become more porous.

24 Interventional cardiology is an exacting and challenging field, which requires high levels of skill, training and dedication.

25 I would urge interventional cardiologists to seize this opportunity to establish their system of training such that the holistic nature of the profession is preserved and the changing needs of an aging population with increasingly complex co-morbidities are addressed.

26 My call is for conscious decisions in such matters rather than to find ourselves blindsided at some point in the not too distant future by developments that we chose to ignore.

27 Moving on, I am happy to note that we have done well in Interventional Cardiovascular Therapeutics in Singapore. It now includes more complex procedures such as percutaneous transcatheter aortic valve implantation, congenital defect closure, endovascular aortic graft implantation and combined percutaneous and open surgical treatments.

28 These treatments are available at our two national cardiac centres, the National University Heart Centre and the National Heart Centre.

29 Both local patients and those from overseas are beneficiaries of these developments.

30 In addition, in our public acute care hospitals, 24-hour emergency primary percutaneous coronary intervention (PPCI) services are available for patients with ST-segment elevation myocardial infarction.

31 The service has reached a high level of efficiency such that most hospitals achieve a door-to-balloon (D2B) time well below the 90 minutes recommended internationally.

32 Similarly the AICT Congress has evolved over the years and remains relevant as a platform for the exchange of expertise and membership continues to grow. The collaborations developed through the AICT platforms have also enhanced existing training arrangements.

33 At the National University Heart Centre and the National Heart Centre doctors from the Asia-Pacific countries such as China, India, Philippines, Indonesia, Myanmar and Vietnam, participate in fellowship training programmes. Over the years some 100 doctors have benefitted.

34 Many of these fellows have since assumed leadership positions in their countries and contribute to the continuing collaborations among our countries and within AICT.

35 These collaborations have also forged the formation of a wide network that facilitates multicentre trials in the region. One such project is the CONTRAST trial, which is evaluating renoprotective regimens to prevent contrast-induced nephropathy in patients with renal impairment undergoing cardiac catheterization.

36 Finally let me assure you that Singapore will continue to invest in the development of interventional cardiovascular therapies. We will provide the best opportunities for our trainees and will continue to collaborate with our colleagues in the region using the platforms such as AICT to create new knowledge for better care for our patients.

37 I therefore hope that all those gathered here today will use this opportunity to strategise further cooperation among our countries.

38 On this note, let me wish everyone an enjoyable and productive conference. Thank you.