Matters concerning the heart are often complex, in both a metaphorical and physical sense. Being the vessel that helps with the circulation of the literal lifeblood that keeps us alive, its intricate structure and functions require many years of study to understand. With the prominence of cardiovascular disease related deaths worldwide, many individuals may be interested in the fields of cardiology. We are honoured to have Dr. Jo Jo Hai, a cardiologist, to answer our questions about pursuing a career in cardiology and share her own experiences with us.
Dr. Jo Jo Hai is a clinical assistant professor in the Cardiology Division in the University of Hong Kong. After receiving her medical degree from the University of Hong Kong, she proceeded to complete her training in Cardiology and Advanced Internal Medicine in Queen Mary Hospital as well as obtaining a cardiac electrophysiology fellowship at Mayo Clinic in America. She is subspecialised in arrhythmia management and associated procedures.
Pursuing a Career in Cardiology
Cardiology is a type of internal medicine specialty, which refers to medical specialities that deal with internal diseases, that covers many specific and complex procedures and mechanisms. Dr. Hai described that important attributes for cardiologists include being aggressive and confident. They must also be decisive as they constantly have to analyse cases and make accurate diagnoses quickly based on clinical evidence as well as their own experience and expertise. This is as many of the patients that arrive are often in serious conditions and may even lack a pulse, and thus cardiologists must quickly make accurate assessments as to how to help the patient. Dr. Hai also emphasized that it is important that doctors learn not to put the burden of patient’s death too much on themselves, as many of the patients will be in critical conditions upon their entry to the hospital.
Despite this, patients suffering from cardiovascular disease also often have a high recovery potential. This is as many of the issues associated with cardiovascular diseases are more clearly identifiable and can be directly tackled. Though patients may use medications or other machinery to help alleviate their symptoms and the severity of the issue, there are also many surgeries available that can help directly eliminate the problem. This reduces the uncertainty of “will the patient ever get better” that may be more common in other internal medicine specialties where patients suffer from long term diseases that require long periods of time to heal from. This was among one of the reasons that Dr. Hai chose to pursue a career in Cardiology.
Life of a Cardiologist
Cardiologists will be expected to both see a lot of patients as well as perform many operations. As a cardiology trainee, one would be expected to wake up early at around 6-7 am and only return home around 9 pm. Upon arriving at the hospital, their day would mostly consist of doing patient visits and rounds, checking on cases and doing operations. They may receive requests for urgent consultations or attend to cases from the Accident and Emergency department. Other than that, much of their day will be focused on receiving cases and consults in the clinic, as well as performing operations. After returning home, they have to continue studying for upcoming exams or furthering their knowledge in the field.
Over time, one may decide to take on a teaching load and become a clinical professor or ease into another role. Along with an increase in administrative work, one may also be able to dedicate more time towards teaching and doing research.
Teaching methods in hospitals
According to Dr. Hai, a common teaching method used in hospitals is the “See one, do one, teach one” philosophy where students are to observe surgeries, then attempt it themselves and finally showcase their skills to others. The phrase “one” is not an arbitrary number showcases the ratio of the amount of procedures that students will eventually monitor, try out and then show. This system was adopted since doctors and medical students have a different learning system and role in the hospital as much of their education comes from their observations as well as hands on experience.
Firstly, medical students or junior doctors are to observe operations carried out by others. During this process, they can start to understand and analyse the reason why specific techniques and steps are used during the operation. Prior to this, it is important that students have a good basic understanding of the procedure and human physiology, much of which may stem from self learning and revision. Once the operation has been carefully observed, students can attempt it themselves with close supervision from supervisors and other senior doctors. Finally, they will continue this cycle by teaching others the procedure which is a valuable opportunity for both parties. This also benefits the demonstrator as it allows them to reflect on their own actions when carrying out the procedure and when explaining it to others. Even if errors are made during the procedure, junior doctors can learn the methods used to tackle the problem, and they may also come up with additional steps that could be added when they themselves attempt the procedure again.
Nonetheless, it is paramount that individuals first reach a certain level of knowledge before pursuing these opportunities. Through self study, watching different web lectures, conducting research in databases or even observing other hospitals, one can expand their understanding on the topic. Once this certain level of knowledge has been acquired, it may be easier for individuals to adapt to the hospital work environment as they can earn the trust of others with more ease and thus be exposed to more learning opportunities.
Experiences in America
Dr. Hai has prior experience working in both the Queen Mary Hospital in Hong Kong as well as Mayo Clinic in America. She described her time at Queen Mary as being a very hands-on experience, stating that the students were constantly supervised by others who held them to a high quality standard.
Dr. Hai described her year working at the Mayo Clinic as a super fruitful experience that exposed her to many new opportunities. During her time, she recalled meeting a multitude of teachers who were all passionate about teaching others. They taught her many complicated operations early on into her fellowship and helped to facilitate her growth as a cardiologist.
Mayo Clinic, located in Rochester, Minnesota, often ranks as the number 1 hospital in the United States. Despite its name containing the phrase “clinic”, Mayo clinic is actually a brand and consists of a big hospital surrounded by other smaller hospital buildings which have different functions. It is the lifeblood to the city of Rochester as around 70% of the inhabitants work at Mayo Clinic. Mayo Clinic is also a Tertiary referral center and a leading hospital for arrhythmia and other heart diseases. This means primary or secondary care providers will refer their patients and cases to Mayo Clinic if there is some difficulty or any other complications or issues. Consequently, Mayo Clinic receives many cases from countries all over the world but largely from America.
These factors allowed Dr. Hai to be exposed to a large number of different cases and gain experience in dealing with them. Dr. Hai fondly recalls her time working at the hospital which consisted of attending classes in the early morning, doing and watching many surgeries during the day, before returning home and going through the hospitals database to watch the recordings of previous surgical procedures.
Research
Even now, many doctors return home from work only to continue reading and conducting research for their papers and theses. Through reading and updating oneself on the newest developments in the medical field, one can perhaps find inspiration for research. This inspiration is often sparked once a gap in knowledge has been identified. From the gaps of knowledge in unique illnesses due to the lack of research to the lack of data for certain ethnicities regarding different illnesses, once these gaps in knowledge have been identified individuals will decide to conduct research to gain more insight and information into that field.
Research often involves reading books, other papers as well as sources online to compile information. During one's years in medical school, many individuals may have attended medical statistics classes which could be useful when conducting research. Though these classes are not mandatory, they allow all students to acquire useful skills concerning the analysis and collection of data. Nonetheless, researchers often work with other departments and personnel who may have other skills that the individual lacks but are beneficial to the research process. Together, individuals can pool their strengths and knowledge to generate research.
For Dr. Hai, she worked in conjunction with the community medicine department along with other organisations to collect data for her own research. Dr. Hai observed that there was a lack of data concerning the number of chinese people who experienced sudden death as it was deemed as a problem that chinese people seldom faced. From this observation, she decided to create a database (that is currently in its final stages of completion) that compiled this data and shared information concerning the issue. To collect data, she had to coordinate with multiple hospitals as well as other organisations such as mortuaries and firefighters. From this research, she was also able to glean other new phenomena and factors that could have affected sudden death. These revelations can help improve current clinical practices as well as spark further research in other fields and lead to overall expansion of knowledge in these areas.
Connection to other fields
This project also proved how many fields of medicine are intertwined. One such field that has a mass impact on virtually all fields of medicine is Epidemiology, the study of the distribution, patterns of transmission and causes of diseases. All medical students will learn about epidemiology in medical school and will use the knowledge gained to accurately access patients in the future. It is necessary for doctors to know which diseases are common in certain areas of the world in order to know what diseases to screen patients for. This can help quicken the process of identifying the illness and finding appropriate treatment methods.
For example, in Asia, tuberculosis is quite common. Thus if young patients in those areas show symptoms of weight loss, poor appetite, it is likely that doctors will consider tuberculosis as the possible diagnosis and perform relevant investigations. This differs from doctors residing in America, in which other conditions like will be suspected and patients will go through many be required to undergo skin tests to check for the illness as its is less common for patients of that ethnicity.
Future of Cardiology
Regarding the specific field of cardiology, Dr. Hai mentioned that most of the current research being conducted surrounds intervention methods as the field of surgery and treatment of cardiovascular disease is already quite advanced. A multitude of surgery procedures have already been developed to treat different Cardiovascular diseases, while a large range of specialised equipment has also already been developed.
Final words of advice
For her final words of advice, Dr. Hai stressed the importance of building a good foundation of knowledge. Though the study process will be arduous and painful at times, it is important to continue learning and building a solid foundation of knowledge as it will allow for better understanding of the concepts and mechanisms involved. Though currently many medical schools put a greater emphasis on critical thinking and problem solving skills, it is of equal importance to have a good foundation in the science subjects. For example, many current medical students have a lesser foundation in physics due to the emphasis on biology and chemistry during schooling. For many topics, this lack of basic understanding of physics related concepts makes it difficult to grasp certain mechanisms in the human body. For example, arrhythmia (problem with the rate or rhythm of the heartbeat) relates to the transfer of electrical signals. This basic understanding of how electrical signals work is necessary to help find the source of the problems as well as understanding the methods used to treat patients.
Aside from this, it is necessary for students to be self reliant. Instead of constantly asking questions and relying on the others to provide answers to them, students should also work hard to find answers themselves.
Dr. Hai helped to provide valuable insight into various aspects of the average life of a doctor such as the learning process and conduction of research, as well as the field of Cardiology as a whole. Through the sharing of her own experiences, we were able to learn about the reasons why Cardiology may/may not be the right fit for us as well as qualities we should possess if we are to enter this field. We hope that this article can help spark passion in our readers and motivate them to work harder to achieve their goals and find the right path for themselves.
