November 2005, Movers & Shakers
Medical Grapevine
By Katrina Eng
Dr Michael Lim shares his passion for advancing medical practice in Singapore
One heart Singapore
Just reading Dr Michael Lim's credentials gives one the impression that the illustrious MP for Pasir Ris-PUnggol GRC must be better at multitasking than anyone else.
Dr Lim is the medical director of the Singapore Heart, Stroke and Cancer Centre (SHSCC) and a consultant cardiologist at Mount Elizabeth Medical Centre. He was also the medical director of Brunei's GJPMC Cardiac Centre and in 2005, he heads the Asian Pacific Society of Cardiology as president.
Other than playing an active role in the Singapore political scene, Dr Lim is also known for his pioneering work in the medical arena. An interventional cardiologist by training, Dr Lim also underwent fellowship training in interventional radiology in the US as well. He was the first doctor in Asia to perform carotid artery stenting for the prevention of strokes in 1995. He made headlines in November 2004 as the first doctor in the Asia-Pacific region to use the new generation 4D CT imaging, which is a cheaper, easier, safer and faster way to scan for heart abnormalities. Using the new 4D scanner has advanced Singapore's thrust to be a regional medical hub as SHSCC is now Philips Medical Systems' reference centre in Asia-Pacific for multi-detector CT imaging.
Medical Grapevine speaks to this advocate of cutting-edge medical technology on his insights regarding the changing medical landscape in Singapore.
Q: Congratulations on being elected president of the Asian Pacific Society of Cardiology, which is one of three major reputable regional bodies in cardiovascular medicine. What are your thoughts on being conferred this prestigious post?
A: I am honoured, as a Singaporean has not filled this position for more than 30 years. I would like to use this opportunity to raise Singapore's profile in the international arena of cardiovascular medicine and advance Singapore's standing as a medical hub through meetings and professional exchanges with overseas counterparts.
Q: What does being the reference centre for Philips mean to SHSCC and Singapore?
A: As the only reference centre in Asia, we work closely with Philips in training and research. With access to Philips' latest technological advancements in imaging heart arteries, SHSCC has become a leading centre in Asia-Pacific with the most experience in imaging heart arteries using this latest technological advancement which offers highly accurate disease detection in heart arteries. SHSCC is even ahead of most centres in Europe and US in the area of imaging of heart arteries as our industry partner has told us that SHSCC has the largest experience and biggest volume of patients in that area. We are glad to be able to do our part for Singapore.
Q: Tell me more about the 4D CT scanner.
A: Current tools used to detect heart abnormalities have limitations. Common tools used for detection of heart disease such as treadmill testing, stress echo and nuclear imaging are not able to visualise the heart arteries. Hence, patients who subsequently present with heart attack may not be detected earlier by these methods.
There is a major misconception that a heart attack is caused by severe narrowing of the heart arteries resulting in eventual complete blockage of the arteries. However, this is often not the case. Usually, a heart attack occurs as a result of a tear of the inner luminal layer of the narrowed segment, especially during stress or vigorous exertion. The body's mechanisms react by forming a clot (as a repair mechanism) to seal the tear, and the resulting clot then occludes the narrowed segment thereby causing a heart attack. Hence, many people who develop heart attacks do not have critical narrowing of the heart arteries and do not have chest pain.
However, the 4D CT scanner is able to pick out such abnormalities in the pre-heart attack stage especially in patients who are suspected to have heart artery disease. As images are well defined and captured in real-time, it also eliminates guesswork when determining the severity of the narrowing in the heart arteries. This outpatient procedure is short and the actual scan is completed between eight to 14 seconds and offers a more convenient and economical alternative to other detection tools.
Furthermore, using appropriate protocols and post-processing techniques, the 4D CT scanner delivers results that are similar in terms of accuracy and consistency to conventional coronary angiography. SHSCC has a scientific paper demonstrating this and it has been accepted for publication by a major international journal. Using protocols and post-processing techniques, SHSCC has been able to produce highly accurate CT coronary angiograms. As a result, SHSCC has stopped using the invasive coronary angiogram as the first step for patients with suspected coronary artery disease.
In addition, other adjacent parts of the body are also scanned by the 4D CT scanner, which means tumours or other diseases can be picked up at the same time.
The advancement of medicine allows detection of heart disease at an early stage and this will result in a major paradigm shift, moving from treating diseases through medical procedures and hospitalisation towards disease prevention. Together with lifestyle changes and appropriate medication, there will be less need from procedures and patients will live longer.
Q: You mentioned that preventive medicine is better than treating diseases. What are the measures you took or are planning to take as an MP to advocate healthy living and improve access of healthcare services to the public?
A: A community health-screening project in early July 2005 created awareness and detected risk factors for heart disease and stroke. In the future, we are looking at the possibility of working with healthcare providers to offer services to needy residents at, or below subsidised rates. This will allow residents to see their doctors within the constituency, obviating the need to travel to hospitals, thus decreasing long waiting time. We are also focusing on adopting early lifestyle changes and early disease detection to decrease healthcare costs.
Q: How has medicine changed over the years?
A: In my younger days, senior doctors were always right; this has changed with the advancement of technology. No matter how junior or senior the doctor, doctors can now make objective and accurate diagnosis through judicious use of medical technology. This levels the playing field for all doctors.
Investigational procedures are also slowly becoming less invasive as technology progresses. This allows GPs to upgrade from managing minor ailments to more serious conditions like heart attacks and strokes with the help of accurate and objective test results. But this is provided they go for continuing medical education on managing these more complex conditions and adopt technology appropriately.
For those with serious heart artery narrowing, percutaneous balloon angioplasty or stenting are favoured over coronary artery bypass graft surgery where it is appropriate.
Percutaneous stenting is performed under local anaesthesia with fast patient recovery. If performed by experienced operators, the risk of major complications is very low compared to coronary artery bypass surgery. The risk ratios vary from centre to centre.
In SHSCC, we have pioneered the concept of "medical" angioplasty which means using lifestyle changes and aggressive medical therapy early to remodel the artery blocked by soft plaques. Many cholesterol-lowering trials have shown that these measures can reduce the risk of heart attack. Together with the 4D CT angiograms, we are now able to demonstrate significant regression of plaque in some patients, obviating the need for angioplasty orsurgery.
Q: What are some future trends in the field of cardiology in Singapore?
A: Firstly, technological advances in medicine will allow early detection and prevention, resulting in fewer procedures, less hospitalisation and longer lives. Medicine will shift from treating diseases to preventing diseases.
Secondly, technology will allow family practitioners to be empowered to manage patients with heart disease and stroke in a more effective manner. They will take a more proactive role compared to their previous passive role of sending patients to specialists. They can help to decrease the costs and reduce the need for expensive hospitalisation and procedures.
Q: How can Singapore become the most advanced medical hub in Asia?
A: Singapore will need people with vision who can anticipate future trends adn directions in the development of medicine, and have a broad-based view of what is happening in the region in terms of competition. We will also need to grow a talent pool of top healthcare professionals. We may not have all these talents in Singapore and we may need to create a milieu to attract these professionals to come here and be absorbed into our talent pool. Finally, we will also need appropriate changes in healthcare policy, legislation and infrastructure to provide a milieu that will allow healthcare professionals with vision, passion and drive to thrive and grow. |
