|Year : 2018 | Volume
| Issue : 1 | Page : 9-11
President's address- VSICON 2017
Past President-VSI, Consultant Vascular Surgeon, 18 Besant Road, Royapettah, Chennai, India
|Date of Web Publication||31-Jan-2018|
Past President-VSI, Consultant Vascular Surgeon, 18 Besant Road, Royapettah, Chennai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vidyasagaran T. President's address- VSICON 2017. Indian J Vasc Endovasc Surg 2018;5:9-11
The Vascular Society of India has completed two decades since inception in 1994. The Society has grown from a small group to more than 400 members including a majority of Vascular & Endovascular Surgeon, Cardiologists, Cardiac Vascular Surgeons and International Radiologists.
It has been a privilege to be your 11th President and I consider this truly the highest honour bestowed upon me, I thank each one of you for having given me the opportunity. As the Society strides into its 25th year, we are over 500 members strong and we have come a long way. In this year's President's Speech, I am going to focus on the Society's achievements over the past few years, the challenges that we face as a speciality, and what I believe the future holds for us.
The Madras Medical College was the first medical school to offer a post-graduate degree in vascular surgery. This epicentre was instrumental in initiating several training programmes across the country. I headed this department for 7 years, from 2007 to 2013. In the first year of taking over, I created the MMC vascular Alumni, under the banner of which annual teaching programme was conducted. It was attended by vascular trainees from all over the country, this was possible with the cooperation of all my vascular colleagues in the state and across the country. I feel, in addition to teaching responsibilities, we must hold administrative responsibilities as well. During this time, I was given the additional responsibility of implementing the state health insurance scheme at the hospital, and this gave me the financial independence to use the funds generated by my department towards making improvements.
Of the many things that I was able to achieve, the most gratifying was the creation of an endo-suite. This initiative came with a little help from my friend Prakash Madhavan, a Consultant Vascular Surgeon in St. James's Hospital, Republic of Ireland. Since the introduction of the endo-suite, I have seen a world of change in the attitude of my junior colleagues and trainees who have now become endo-competent. This has also paved the way for other teaching institutions in the state to achieve similar standards. I would like to highlight this as an important achievement, and as Frank Veith said in his Presidential Address two decades ago - ”specialities are like species, they must evolve or go extinct”. His prophesy, it seems has come true. When people ask me what it was like to work in the government, I would laugh and say “it's like going to the sea – you learn to swim with the sharks and yet have a whale of a time”.
After my retirement from the government, I spent the next four years in a private institute – Sri Ramachandra University (SRU), Chennai. I was among the few who had the credentials to validate their department of vascular surgery. I took on this role out of passion for teaching and love for my young consultants. I have always been a strong advocate for exchange programs which was initiated during my previous assignment, and at SRU, I was able to send our trainees to Austria for international experience, thanks to Prof. Thomas Hölzenbein at the University Hospital in Salzburg, Austria. I have also encouraged my trainees to attend international meets and in fact one of them won a prize at the 2016 VEITH symposium for a presentation of an innovative surgery done at SRU.
The last 2 years have brought increasing collaboration and bonds of friendship with other associations. The European Society for Vascular Surgery (ESVS) has named a representative from the VSI as a member of council. The Australian and New Zealand Society for Vascular Surgery (ANZSVS) have approached us to have a joint session during the 2019 conference at Adelaide. We have also been offered the Secretary General position at the World Federation of Vascular Societies (WFVS) for the next 4 years. I hope to see these bonds continue to strengthen.
More on the Society's achievements – The Indian Journal of Vascular and Endovascular Surgery (IJVES) is more vibrant than ever and its circulation continues to rise. We have had some excellent contributions from our postgraduates and I hope to see this sustain and improve in the years to come.
Recognising the need to restructure vascular training programs in India, I have started the Academic Council. I will shortly touch upon what we hope to achieve through this Council in the future.
These are only a few of our achievements and I am greatly indebted to each one of you for the work you do every day. Special thanks to Kal Suresh (Editor-IJVES), Varinder Bedi, Khumud Rai, N Sekar, S A Hussain, Pinjala Ramakrishna, Ramesh Tripathi, R C Sreekumar, the EC and EB for their contribution and support to the Society.
| Moving on to Challenges We Face|| |
The vascular advances in our country have traditionally been built on advances in other countries. However, it is of utmost importance that we focus on addressing issues that are unique to our patient populations. Our disease patterns do not mirror the west. Morphologically, we are smaller built and pathologically, we tend to see a fair amount of non-specific arteries. The western world is not going to come up with solutions for us, neither can we use their guidelines per se and hope to achieve similar results. It therefore becomes imperative for us to actively involve ourselves in not only population and retrospective studies, but also in experimental studies, randomised controlled trials, and innovations. This is an area in which we lag behind, probably because our training structure does not offer sufficient guidance in research methodologies. The issue is also further compounded by the non-existence of a national or sub-national registry for vascular cases.
The need for skilled vascular surgeons will continue to increase with an ageing demographic and diabetic population. Although several training programs have recently been initiated across the country, we face challenges in the standardisation of training in terms of curriculum, case volume and variety, as well as access to institutional resources. Though we face competition from cardiologists, cardiothoracic surgeons and interventional radiologists, it is heartening to know that a large number of these patients require our specific set of skills and often identify vascular surgeons as their key doctor.
There are also special issues that we face in our country, since a large majority of our patients have limited financial resource. I feel the most durable procedure should be offered to our patients since any secondary re-do procedures will be a financial burden and often cripples the family. So the judgement for endovascular or surgery should be based on best possible outcomes at our centre. Another area of concern is whether unnecessary procedures are being done, the exponential rise in the number of procedures since the advent of less morbid endo-luminal procedures suggests this. The responsibility lies with our Society, emphasizing the need for initiating guidelines for our patient population.
| The Future|| |
With increasing endo-vascular interventions, our future must focus on safety and durability of procedures. Innovations in technology like fusion imaging have improved ease of navigation and outcomes. However, concerns regarding radiation exposure have been raised. New modalities to use the same technology with 4D ultrasound will reduce the radiation exposure to surgeons and other personnel, as well as minimise contrast burden to the patients.
Although revision procedures, when necessary, are safer with endovascular techniques, we have to factor in the cost to our patients in India. The government has already looked into fixing standard reimbursement rates for stents. Moving forward, we will have to negotiate with insurance companies to ensure fairness in compensations provided to surgeons and patients alike.
The next key factor in safe-guarding our future is going to lie in teaching and training our youngsters. Although it is well known that working in an academic setting is not as lucrative as private practice, it is important for sacrifices to be made to further our specialty. I believe I have carried forward the good work of my mentors and hope my students will do the same – the cycle must go on.
Overall, Programme Directors across India must be pleased that the endovascular revolution has occurred in all teaching institutions. However, there are lessons to be learnt from the West, where the endovascular- first approach has reduced the number of open procedures, which in turn has affected the training of new graduates. But this has been addressed by most of training institutions in India and at this stage, and I believe we have a balanced approach in advocating treatment modalities to our patients. So I do not feel that this will be a concern in the immediate future.
I see a very important role for the Academic Council in the future. We hope to establish an integrated curriculum for MCh and Diploma in National Board (DNB) in order to have national standardisation. We have suggested in-training examinations for our trainees, with external examiners from other institutions. We have talked about having our trainees collaborate with statisticians and biomedical engineers to place them in the forefront of innovation. And finally, I think the future might also involve vascular sub-specialisations, especially in diseases of the aorta.
I grew up in an era where doctors had empathy and greatest concern for their patients. But I feel the advent of rapid changes is making today's physicians show less concern. As words of motivation, I would like to present the following quote by William Osler, the man recognized worldwide as the Father of Modern Medicine. From his 1905 farewell address to Johns Hopkins University:
“I have three personal ideals. One to do the day's work well and not to bother about tomorrow.
The second ideal has been to act the Golden Rule, as far as in me lay, towards my professional brethren and towards the patients committed to my care.
And the third has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affections of my friends without pride, and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man”.
I must thank my parents for having taught me the importance of hard work, honesty, humanity and dedication to my profession; my wife, Dr. Vasanthi, is a great blessing – she has been my companion and good friend. She would never accept an excuse for my failing to achieving something that I was capable of, and I thank her for that motivation. My daughters have both followed our footsteps by becoming doctors. My students, to whom I hope I have been a source of inspiration, many have made me proud. They are all over the world, making their contributions. Roy Greenberg once said “I want my children to know that the world is a small place with friends everywhere to go”. My children, both living abroad, have seen this become a reality in their lives.
I would also like to thank my teachers – Prof. R. Saratchandra, N. Rangabhasyam, R. Nanjundarao, and my brother, T Gunasagaran, without whose guidance, I would not be where I am today. I am grateful to every member of the Department of Vascular Surgery who were instrumental in my contribution and to a large patient population who patronize the prestigious Government General Hospital, Madras Medical College. Vascular surgery in India is vibrant and I am humbled by your presence here at this gathering. I want to end by saying that I have always lived my life on the one guiding principle – “to give more than what I received”.