Presidential Address

Dr. Suyash Kulkarni

Dear Colleagues,

If I see far, it is because I stand on the shoulder of giants. We are all a part of the historic journey begun by Charles Dotter in 1964, and the inheritors of his legacy. The idea of treating pathologies through pinholes under imaging guidance was a fundamental shift in surgical approach, and the reverberations of that historic act in 1964 inspire and energise us to this day.

We have become to an extent , victims of our own success. If imitation is the sincerest form of flattery, then we can pride ourselves that all those who ridiculed our beginnings are now paying us compliments every day! From the time of visualize but do not fix to now, we have seen the organic growth of a vital and transformative specialty that is respected across the board.

With great power comes great responsibility .. and with our shift from diagnosticians to proceduralists to clinicians, comes the responsibility of patient care and interaction with the patient at every stage. This is a choice that has been made for us by the nature of our task, if we want respect as clinicians and the power to transform lives with our interventions, we must hold paramount the duty of interacting with the patient at every stage of the clinical pathway. We must see, touch and communicate with our patients at every available opportunity. This ancient and sacred bond between the healer and the sick is one that we must nurture and make the cornerstone of our practice. Fail this test, and we will be doomed to recede and die as a specialty.

We as IRs have a serious problem. We are a hidden specialty, like a commando or a special forces person that is called in at the last minute to save the world. Attractive as this image may be to screen writers for blockbuster superhero movies, it is not the image we need for IR. We must be seen as not the last resort, but the first. We must be consulted on a day to day basis by others for our skills, our knowledge and our reliability. The path to this growth lies in introspecting and examining what we do on a day to day basis. We must look to be reliable, efficient and cost effective. We must be relevant to the clinical needs of our patients and our colleagues. We must look not for immediate gratification and short term gains, but for long term growth.

I propose that we look at bringing IR to the consciousness of the patient population as physicians who are to be consulted for solving their problems. We have the best solutions , based on evidence, to many common disorders. Translating that into routine practice has however been difficult. Most patients in India will never be offered the safer and less invasive options we have developed. We must launch a campaign to educate the people about who we are and what we do. This is a task for ISVIR, and we all must contribute to this.

We have all seen the change in our environment as Doctors. The increasing hostility and the violence that some of our colleagues have faced and continue to face is a fact of life. I hold no brief for the people who demonise our profession, but who amongst us can say that we have never known of less than defensible actions by our fellow professionals? It is time that we as a society took up the task of ensuring that we establish standards of care and perhaps credentialing that show our commitment to improving quality and maintaining standards. This is a very large task, and daunting too, but can we leave it to others to decide these issues for us?

Training of IRs is one of the mandates of our society, and over the years we have contributed to the growth of IRs in this country. The formalization of degree courses such as DM and NBE in IR has happened. Now it is time for us to grow centres which will give us the IRs of the future. I call upon all institutes with large IR practice and thought leaders to participate in this and establish more centres offering IR degrees. There is an immense need for IR specialists in all corners of the country, and we must meet it.

The life of an IR is one of constant learning, and one of our focus areas has to be continuation of education. ISVIR is committed to carrying out training courses and CMEs through the year for improving skills of trained IRs.

There is a very large issue of “Turf Wars”. I believe we must have a twofold approach to this. The first part is to outline standards of care and credentialing requirements as well as improve our training standards to meet the highest in the world. In this endeavor we will look to assistance form our more mature partners in other parts of the world to show us the way. The second part is to form a lobbying group for interfacing with the regulatory bodies to ensure that persons with lesser training and skills are not allowed to perform these procedures by virtue of their training in other areas. We respect the skills of all our professional colleagues from other fields, and we believe the best results are achieved by multidisciplinary collegial approach, but I believe it is our duty to insist that if we have better skills and training to perform the tasks, others should not be permitted to perform those tasks. I don’t believe we can pussyfoot around this issue anymore.

IR is seen as a specialty that is a luxury rather than need, “nice to have” rather than “must have”. Part of the problem is perceived “expensive” nature of our procedures. Over time with increasing volumes, there has been a decline in cost of devices and equipment. There remains, however, a need for inculcating the idea of efficiency. We must try to make our procedures efficient in terms of manpower requirement, device use and infrastructure dependence. We must look to doing it “Better, Faster, Cheaper”. Our society has amongst the best brains in the business, and some of the best businessmen! The only way forward for us is to recognize what the future is saying to us :

Innovate or Die!