#UseHeart to Keep Moving | In Conversation with Dr. Anil Jain

Dr. Anil Jain is a renowned leader in aortic valve repair surgeries and his expertise encompasses the entire spectrum of adult cardiac surgery. He currently serves as the Director of Cardiac Surgery and as Founder at Epic Hospital, Ahmedabad, India.

For Dr. Jain, his fascination for cardiac surgery goes hand in hand with his contribution to developing new treatments for cardiovascular diseases. He has been actively associated with some of the leading clinical trials including those in cardiac drugs and devices as a Principle Investigator and has also been pivotal in publishing research papers evaluating the successful outcomes of his patients.

Namita Narkar: Dr. Jain, to begin with, thanks for granting this interview and heartiest congratulations on Epic Hospital’s completion of one year this week! How does it feel on achieving this milestone?

Dr. Anil Jain: Thanks, Namita, the pleasure is mine.

Yes, it definitely feels good that Epic Hospital has completed a year. It was always a dream for me to build a hospital. Not sure if many know about it, but I was involved in the establishment of the Sterling Hospital way back in 2000. I did work in getting the project together but then left it for various reasons. After then I was with SAL Hospital for almost two decades until last year September.

Today that we have completed a year, it feels much rewarding and I want to thank all those who stood by me in this long endeavour and became a part of my dream. Unfortunately, after just five and a half months of full-fledged functioning, we were hit by the Covid-19 pandemic and things went downhill with low occupancies making it difficult for us to sustain. But then some strategic decisions were taken. We opened up the doors for specialists and consultants and that turned out to be good for us. Now things are getting back on track, because we can delay healthcare but we cannot postpone it indefinitely.?

NN: You have always been associated with country’s some of the busiest cardiac units in a corporate setup. What drives Dr. Jain every single day?

AJ: Well, your question has to be framed differently [chuckles] because I’ve not been associated with the busiest cardiac units, but I have kept my units one of the busiest units in the country. I don’t think many private units have done the kind of work we’ve done. We’ve been doing around 1700 cases a year and that’s a lot for a private unit that does not perform any scheme or reimbursement procedures.

Well, to be honest, for me it was a dream to be a cardiac surgeon. Right from my school or medical college days, whenever you may say it from, I always dreamt of pursuing cardiac surgery. My passion for cardiac surgery has been driving me all these years, especially being able to treat patients and address cardiac ailments that are challenging in nature. In short, it’s the work that drives me and not the other way round.

NN: Starting one’s own institute is no small feat. Now that you have already reached first of the many milestones you are set to achieve, what’s your vision for Epic Hospital?

AJ: Throughout my life, I have always faced one problem as a doctor. We are often at the mercy of the hospital owners or investors and we are given the impression that the hospital obliges us by letting us work at the institute. There are times when we even have to convince them for equipment necessary to us. And that makes me think how correct is that? Do hospitals need doctors or do doctors need hospitals? Or is the need mutual? Hospitals forget that it is a mutual requirement because a hospital without a doctor is non-functional. So my vision at Epic is to give my colleagues an access to ultra-modern care. I wish to make Epic Hospital a springboard for new surgeons helping them develop their talent. So at Epic, if I dream and dream it right, I want to make it a talent pool for the medical fraternity.

And when it comes to patients, I don’t know if you’ve watched the movie Patch Adams, when the protagonist, played by Robin Williams says, “Death is not the enemy Sir, Indifference is! You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.” This is exactly my philosophy when it comes to my patients. We want every patient coming to us to be treated with respect, compassion, and dignity. At the end of the day, only if the patient is happy, it is a win-win for all.?

NN: For the given prevalence of cardiovascular diseases (CVDs) in India, is India’s cardiac infrastructure equipped to handle the growing trends?

AJ: 50% of all the mortality in India is attributed to CVDs. That is what the data from World Health Organization or the Indian Council of Medical Research says. At present if we look at all the institutions across India, within the fields of cardiac surgery as well cardiology, there’s an uneven distribution of cases. There’s a lot of work in government hospitals, or at those hospitals which accept scheme patients, at the same time, there are other centres that are languishing for work. If we truly go out and diagnose all the patients and bring everybody to the hospital then we will certainly fall short of beds. But according to me the real challenge facing us is different. In past few years, fewer and fewer doctors have taken up cardiac surgery and we hear of cardiac surgery seats going vacant. Like any other skill set, Cardiac Surgery is not one you can acquire easily. It is a skill set that is pretty difficult and takes a lot of efforts to master, that’s the reason why there’s a difference between a craftsman and an arts man. Proper training and skilled cardiac surgeons who can produce results are a necessity. We also need a well-trained technical support staff that can support surgeries. So if you ask me, 10 years down the line there’ll be more work than you can imagine but we’ll have few surgeons who can operate them.?

NN: That brings me to my next question, what would you advice anyone wanting to start his own setup? Things one should do and should not do?

AJ: We need to start with three premises before we take a plunge in setting up a hospital –

Patients - want to pay as less as possible; Doctors - want to be well-paid; and Investors - want to maximize the returns on their investment.

In fact I am of the strong belief that doctors are the best people to invest in and build a hospital and not the investors. With the Epic experience under my belt, I’d say a great deal of attention has to be paid to reverse integration when building a hospital. To put across the message as briefly as possible, here are my key messages:

• Get as realistic as possible on the amount of work a surgeon has and the manpower required to support the work with concrete projections on paper
• Get precise on the investments needed; every sq.cm of investment matters and makes a difference in the long run
• Implement absolute optimization, whether is it in planning spaces, hospital workflows, or even in equipment purchases
• Introduce as much automation as possible; lesser the manpower the better it is because hospitals are anyway manpower dependent
• Complete the detailed planning, layouts, to the last bit before your start putting in your money
• Don’t develop a speciality because you think you’ll run it in the future; never bring in the equipment hoping you’ll have consultants to use them
• Don’t build extravagant infrastructure at the expense of excellent equipment, theatres, and instruments; invest in just what you need, nothing extra

These points may look very obvious to you, but believe me, I have seen institutes commit these mistakes.?

NN: Dr. Jain, those were some real pearls of wisdom!

The global Covid-19 pandemic has challenged our healthcare system in multiple ways. Do you see a significant impact in the areas of cardiovascular care as well?

AJ: The Covid-19 pandemic has been too harsh with all of us, largely because we don’t know when all of this will end. During the lockdown, patients deferred receiving care and a lot of patients are now coming in with emergencies. And when they do, the challenges we face are twofold.

One, owing to Covid-19, patients fear approaching healthcare facilities and suffer at home, and when they do reach us, they are Covid-19 positive, which makes it even more challenging to treat them.

Two, for example, a patient with breathlessness, will be first checked for Covid-19 and is not treated for the primary condition immediately causing a delay in the necessary treatment.

To sum it up, the pandemic has immensely influenced the delivery of cardiovascular care, and we are unsure how long we have to deal with this.?

NN: This year’s World Heart Day’s theme is #UseHeart to reach, influence, share, amplify, and of course to beat CVDs. Given the challenging times the world is facing, what’s the one thing you would advise all of us when it comes to #UseHeart?

AJ: These are difficult times for all of us, so patients should follow the instructions from healthcare workers. Wearing masks in the hospital, observing social distancing norms and protocols, respecting the doctors and the staff because they are putting themselves at risk for the patients. #UseHeart to respect the healthcare workers who’ve been working hard for all of us.

And if I have to give one advice to keep our hearts healthy, then it is to keep moving! The ongoing pandemic has made people armchair freaks which can only worsen your health. So remember, the longer you keep moving, the longer you will live!?

NN: Dr. Jain, thank you so much for your time and thoughts! It was great talking to you and I am confident that our readers will enjoy reading every bit of this conversation.

Wishing you too a Happy #WorldHeartDay 2020!